Effectiveness of the fixed-dose combination therapy with perindopril and amlodipine in coronary heart disease patients after coronary artery bypass graft surgery
https://doi.org/10.15829/1728-8800-2011-6-47-54
Abstract
Aim. To study the effectiveness of the fixed-dose combination therapy with perindopril and amlodipine (Prestance 5/5 mg/d) in coronary heart disease (CHD) patients after coronary artery bypass graft (CABG) surgery.
Material and methods. The clinical trial included 65 patients (37 men, 28 women aged 45-68 years; mean age 56,3±3,5 years) after CABG. All patients were randomised into two groups: the control group (CG; n=35) and the main group (MG; n=30). Both groups received antiplatelet agents and statins, while the MG patients additionally received Prestance (5/5 mg/d). Prestance therapy started three-four weeks after CABG and lasted for four months. All participants underwent 24-hour monitoring of ECG and blood pressure (BP), Doppler echocardiography, and Doppler ultrasound of brachial and common carotid arteries.
Results. Compared to the CG, the MG demonstrated decreased incidence of pain and painless ischemia episodes, reduced maximal ST segment depression and its total duration, and increased rate threshold of myocardial ischemia. In addition, Prestance therapy was associated with improved systolic and diastolic heart function and significantly improved endothelium-dependent vasodilatation. In patients with normal BP, Prestance (5/5 mg/d) did not cause hypotension, but reduced excessive BP variability. In the MG, acute coronary syndrome (ACS) was registered in 1 individual (3,3 %), while in the CG, it was registered in 4 patients (11.4 %), and in 3 cases, coronary artery stenting was performed.
Conclusion. In patients with normal BP, Prestance (5/5 mg/d) therapy in the early post-CABG period had a pronounced anti-ischemic, cardio- and vasoprotective effects, and also prevented excessive BP variability.
About the Authors
B. G. Iskenderov
Penza Institute of Post-diploma Medical Education
Russian Federation
Penza
Russian Federation
Penza
O. N. Sisina
Penza Institute of Post-diploma Medical Education
Russian Federation
Penza
Russian Federation
Penza
O. A. Kameneva
Penza Institute of Post-diploma Medical Education
Russian Federation
Penza
Russian Federation
Penza
References
1. Добровольский А.В. Место производных дигидропиридина в лечении заболеваний сердечно-сосудистой системы (современное состояние проблемы). РМЖ 2008; 16(11): 1599-608.
2. Карпов Ю.А. Оптимальное лечение артериальной гипертонии и ишемической болезни сердца: аргументы в пользу комбинации периндоприла аргинина и амлодипина. Cons Med 2010; 5: 51-6.
3. Клюжев В.М., Ардашев В.Н., Брюховецкий А.Г., Михеев А.А. Ишемическая болезнь сердца. М.: Медицина 2004; 202-29.
4. Российские национальные рекомендации по диагностике и лечению артериальной гипертензии. Сист гиперт 2010; 3: 5-26.
5. Шевченко Ю.Л., Виллер А.Г., Белевитин А.Б. и др. Особенности кровоснабжения миокарда после аортокоронарного шунтирования в раннем послеоперационном периоде. — В кн.: Тезисы докладов IV Всероссийского съезда сердечно-сосудистых хирургов. М. 1998; 71.
6. Bahl VK, Jadhav UM, Thacker HP. Management of hypertension with the fixed combination of perindopril and amlodipine in daily clinical practice. Results from the STRONG Prospective Observational Multicentre Study. Am J Cardiovasc Drugs 2009; 9 (3): 136-42.
7. Bertrand M, Sever P. Synergistic effect of perindopril and calcium channel blockers in prevention of cardiac events and death in coronary artery disease patients: analysis from the EUROPA study (abstract 3267). Congress of the European Society of Cardiology (ESC). Munich, 2008.
8. Celermajer DS, Sorensen KE, Gooch VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340: 1111-5.
9. Costanzo P, Perrone-Filardi P, Petretta M, et al. Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175 634 patients. Hypertens 2009; 27: 1136-51.
10. 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 randomized controlled trial. Lancet 2005; 366: 895-906.
11. Dens J, Desmet W, Piessens J. An updated meta-analysis of calcium-channel blockers in the prevention of restenosis after coronary angioplasty. Am Heart J 2003; 145 (3): 404-8.
12. Doggrell SA. Has the controversy over the use of calcium channel blockers in coronary artery disease been resolved? Expert Opin. Pharmacotherapy 2005; 6 (5): 831-4.
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. Gunning M, Chua T, Harringhton D, et al. Hibernating myocardium: clinical and functional response to revascularization. Eur J Cardiothorac Surg 1997; 11: 1105-12.
15. Jamerson KA, Weber MA, Bakris GL, et al. On behalf of the ACCOMPLISH investigators Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417-28.
16. Jorgensen B, Simonsen S, Endresen K. Restenosis and clinical outcome in patients treated with amlodipine after angioplasty: results from the Coronary AngioPlasty Amlodipine REStenosis Study (CAPARES). JACC 2000; 35(3): 592-9.
17. Ker J. Combination treatment for hypertension. SA Fam Pract 2010; 52 (5): 417-21.
18. Koh KK, Han SH, Ahn JY, et al. Amlodipine improves endothelial function and metabolic parameters in patients with hypertension. Int J Cardiol 2009; 133 (1): 23-31.
19. Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004; 292 (18): 2217-25.
20. Pitt B, Bryington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation 2000; 102: 1503-10.
21. Rodriguez-Granillo GA, Vos J, Bruining N, et al. Long-term effect of Perindopril on coronary atherosclerosis progression (from the PERindopril’s Prospective Effect on Coronary aTherosclerosis by Angiography and IntraVascular Ultrasound Evaluation (PERSPECTIVE) Study. Am J Cardiol 2007; 100: 159-63.
22. The EUROPA investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362; 782-8.
23. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the EUROPEAN Society of Cardiology. 2007 Guidelines for the management of arterial hypertension. J Hypertens 2007; 25: 1105-87.
24. Ceconi C, Fox KM, Remme WJ, et al. ACE inhibition with perindopril and biomarkers of atherosclerosis and thrombosis: Results from the PERTINENT study. Atherosclerosis 2009; 204: 273-5.
25. Недогода С.В. Применение антагонистов кальция для профилактики сердечно-сосудистых осложнений при операциях на сердце. РФК 2006; 3: 56-64.
Review
For citations:
Iskenderov B.G., Sisina O.N., Kameneva O.A. Effectiveness of the fixed-dose combination therapy with perindopril and amlodipine in coronary heart disease patients after coronary artery bypass graft surgery. Cardiovascular Therapy and Prevention. 2011;10(6):47-54. (In Russ.) https://doi.org/10.15829/1728-8800-2011-6-47-54
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