Combined antihypertensive therapy in patients with arterial hypertension and coronary heart disease
https://doi.org/10.15829/1728-8800-2011-3-28-34
Abstract
Aim. To assess the potential of adding perindopril and indapamide CR (controlled release) to standard therapy, as a method for additional correction of cardiovascular risk factors (RFs) among patients with Stage 1-3 arterial hypertension (AH) of very high risk and coronary heart disease (CHD).
Material and methods. In total, 44 patients (29 men, 15 women; age 45-80 years, mean age 56±10,7 years) with Stage 1-3 AH of very high risk and CHD were examined. At baseline and after 2, 4, and 16 weeks of the treatment, all participants underwent physical examination, office blood pressure (BP) measurement, standard laboratory tests, electrocardiography (ECG), Holter ECG monitoring, 24-hour BP monitoring, echocardiography (EchoCG), and arterial stiffness assessment.
Results. All participants completed the study protocol, with no adverse effects during the treatment phase. In all patients with Stage 1-3 AH, target BP levels and improved 24-hour BP profile were achieved. In CHD patients, a reduction in the incidence of ischemic episodes and their duration was observed. There was a positive dynamics of arterial stiffness parameters.
Conclusion. Perindopril and indapamide CR demonstrated good antihypertensive effectiveness, as well as cardioand vasoprotective activity in patients with very high-risk AH and CHD.
About the Authors
O. A. AgeenkovaRussian Federation
Smolensk
V. A. Milyagin
Russian Federation
Smolensk
M. A. Purygina
Russian Federation
Smolensk
References
1. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217-23.
2. Шальнова С., Кукушкин С., Маношкина Е., Тимофеева Т. Артериальная гипертензия и приверженность терапии. Врач 2009; 12: 39-42.
3. Kaplan NM, Clinical Hypertension. Philadelphia, PA: Lippincott, Williams & Wilkins, 2006.
4. Карпов Ю.А., Шальнова С.А., Деев А.Д. от имени участников программы ПРЕМЬЕРА. Престариум у больных с артериальной гипертонией и ишемической болезнью сердца (или факторами риска) — безопасное достижение целевого уровня артериального давления (ПРЕМЬЕРА): результаты клинического этапа национальной программы. Кардиология 2006; 6: 32-8.
5. Карпов Ю.А., Деев А.Д. от имени врачей — участников исследования ПРИВИЛЕГИЯ. Исследование ПРИВИЛЕГИЯ — ПРестарИум В леченИи артериаЛьной гипЕртонии: антиГИпертензивнаЯ эффективность и безопасность в сравнении с эналаприлом. Кардиология. 2007; 7: 35-40.
6. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiolody. 2007 Guidelines for the management of arterial hypertension. J Hypertens 2007; 25: 1105-87.
7. Российское медицинское общество по артериальной гипертонии (РМОАГ), Всероссийское научное общество кардиологов (ВНОК). Диагностика и лечение артериальной гипертензии. Российские рекомендации (4-й пересмотр). Сист гиперт 2010; 3: 5-26.
8. Pepine CJ, Handberg-Thurmond E, Marks P, et al. Rationale and design of the International Verapamil SR/Trandolapril Study (INVEST): an internet — based randomized trial in coronary artery disease patients with hypertension. JACC 1998; 32: 1228-37.
9. Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366: 895-906.
10. The EUROPA investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362; 782-8.
11. Perindopril: a major contribution to the prevention and treatment of cardiovascular disease. Edited by Ferrari F & Fox KM. Volters Kluwer, 2008.
12. The PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033-41.
13. Ferrari R. for the PREAMI investigators. Effects of ACE inhibition with perindopril on left ventricular remodeling and clinical outcome. Arch Intern Med 2006; 166: 659-66.
14. ADVANCE Collaborative Group. Effects of fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370: 828-40.
15. Gosse P, Sheridan DJ, Zannad F, et al. Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1,5mg versus enalapril 20mg: the LIFE study. J Hypertension 2000; 18(10): 1465-75.
16. Seventh report of the Joint National Committee on Prevention, Detection, Evalution and treatment of High Blood Pressure. J Hypertension 2003; 42: 1206-52.
17. Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists Collaboration. Lancet 2000; 356: 1955-64.
18. Yusuf S, Sleight P, Pogue J, et al. The Heart Outcome Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145-53.
19. Марцевич С.Ю., Лукина Ю.В., Дмитриева Н.А. и др. Сравнение нового дженерика и оригинального препарата рамиприла у больных артериальной гипертонией и высоким риском сердечно-сосудистых осложнений. РФК 2010; 6(1): 20-8.
20. Желнов В.В., Петровская Н.В., Комарова И.С. Низкодозовая комбинированная терапия АГ. РМЖ 2008; 16(16): 1049-53.
21. Белоусов Ю.Б., Леонова М.В. Клиническая эффективность нового b-адреноблокатора небиволола у больных артериальной гипертонией (результаты многоцентрового исследования). Кардиология 2000; 9: 27-32.
22. Иваненко В.В., Семенова Н.В., Рязанцева Н.В. и др. Влияние индапамида ретард на процессы сердечно-сосудистого ремоделирования у пациентов с артериальной гипертонией. Артер гиперт 2003; 9; 5.
23. Недогода С.В., Чаляби Т.А., Цома В.В. и др. Сравнительная эффективность оригинального и генерического лозартана у больных артериальной гипертензией. Кардиоваск тер профил 2007; 6(6): 10-4.
24. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981-97.
25. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755-62.
26. Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995-1003.
27. Verdecchi P, Schillaci G, Borgioni C, et al. Ambulatory Pulse Pressure A Potent Predictor of Total Cardiovascular Risk in Hypertension. J Hypertens 1998; 32(6): 983-8.
Review
For citations:
Ageenkova O.A., Milyagin V.A., Purygina M.A. Combined antihypertensive therapy in patients with arterial hypertension and coronary heart disease. Cardiovascular Therapy and Prevention. 2011;10(3):28-34. (In Russ.) https://doi.org/10.15829/1728-8800-2011-3-28-34