Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Antihypertensive Efficacy of Fixed Combination of Amlodipine and Ramipril in Patients with Arterial Hypertension and Very High Cardiovascular Risk

https://doi.org/10.20996/1819-6446-2018-14-6-840-845

Full Text:

Abstract

Aim. To evaluate the antihypertensive efficacy and tolerability of a fixed combination of amlodipine and ramipril in hypertensive patients with very high cardiovascular risk. Material and methods. A retrospective cohort study of real clinical practice of prescribing antihypertensive drugs according to 255 medical records of outpatient hypertensive patients with a history of acute coronary syndrome (ACS) and coronary artery stenting was performed in the first part. An open observational study was performed in the second part. 69 people older than 18 years with a history of ACS and coronary artery stenting, without reaching the target blood pressure (BP) level while using free combinations of antihypertensive drugs and with indications for a fixed combination of ramipril and amlodipine were included into the study. Analysis of self-monitoring of BP, office BP, daily BP monitoring (ABPM) and patients’ adherence to treatment (Morisky-Green test) initially, after 4 and after 12 weeks of taking the fixed combination of ramipril and amlodipine was performed to assess the clinical efficacy of the studied drug. Results. It was found that 42.0% of patients did not follow the recommendations for regular intake of antihypertensive drugs. So, hypertension of all patients regarded as false-refractory, which was the basis for the prescription of the fixed combination of ramipril and amlodipine in accordance with clinical guidelines for the diagnosis and treatment of hypertension. After 4 weeks of therapy, there was significant decrease in office BP with the achievement and preservation of the target level by the 12th week, normalization to the 12th week of day and night BP variability in 54.9% of patients. 78.0% of patients followed medical recommendations for regular administration of antihypertensive drugs, none of the patients had adverse events. Conclusion. The use of fixed combinations of drugs, in particular, amlodipine and ramipril as a part of multicomponent therapy in hypertensive patients with very high cardiovascular risk, led to the achievement of target BP by the 4th week of therapy and stable preservation of antihypertensive effect in 12 weeks of treatment as well as gradual normalization of day and night BP variability in more than half of patients. Fixed combination of ramipril and amlodipine allowed to improve adherence of patients to cardiovascular diseases.

About the Authors

O. Yu. Korennova
Omsk State Medical University; Omsk Clinical Cardiology Dispensary
Russian Federation
MD, PhD, Professor, Chair of Internal Diseases and Family Medicine, Omsk State Medical University; Deputy Chief Physician, Omsk Clinical Cardiology Dispensary


S. P. Podolnaya
Omsk Clinical Cardiology Dispensary
Russian Federation
MD, Cardiologist


E. P. Prihodko
Omsk Clinical Cardiology Dispensary
Russian Federation
MD, Head of Department of Medical Rehabilitation


E. A. Turusheva
Omsk Clinical Cardiology Dispensary
Russian Federation
MD, PhD, Head of Day Hospital


S. N. Starinskaya
Omsk Clinical Cardiology Dispensary
Russian Federation
Head of Functional Diagnostics Department


I. A. Вratishko
Omsk Clinical Cardiology Dispensary
Russian Federation
MD, Cardiologist


I. V. Druk
Omsk State Medical University
Russian Federation
MD, PhD, Professor, Chair of Internal Medicine and Family Medicine


References

1. Mancia G. Highlights of the August issue. J Hypertens. 2018;36:1611-13. doi:10.1097/HJH. 0000000000001822.

2. Sumin A.N., Korok E.V., Shcheglova A.V., Barbarash O.L. Comorbidities in Patients with Ischemic Heart Disease: Gender Differences. Rational Pharmacotherapy in Cardiology. 2017;13(5):622-9 (In Russ.) doi:10.20996/1819-6446-2017-13-5622-629.

3. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi:10.1093/eurheartj/eht296.

4. Velizhanina I.A., Gapon L.I., Velizhanina E.S., A.V. Use of fixed combinations of ramipril and hydrochlorothiazide in patients with arterial hypertension and high or very high cardiovascular risk (OPTIMIST 2 study): results of the noncomparative study. Rational Pharmacotherapy in Cardiology. 2011;7(4):426-30 (In Russ.) doi:10.20996/1819-6446-2011-7-4-426-430.

5. Chesnikova A.I., Koshenskaja I.N., Terentyev. Ramipril еfficacy in patients with arterial hypertension and ischemic heart disease. Rational Pharmacotherapy in Cardiology. 2008;2:41-6 (In Russ.) doi:10.20996/1819-6446-2008-4-2-41-46.

6. Chazova I.E., Martynyuk T.V., Ratova L.G. Angiotensin-converting enzyme inhibitors in focus: ramipril in arterial hypertension. Sistemnye Gipertenzii. 2011;3:5-10 (In Russ.)

7. HOPE study investigators. The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. Can J Cardiol. 1996;12:127-37.

8. Shalnova S.A., Balanova Yu.A., Konstantinov V.V. Arterial hypertension: prevalence, awareness, antihypertensive pharmaceutical treatment, treatment effectiveness in Russian population. Russian Journal of Cardiology. 2006;4:45-50 (In Russ.)

9. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on progression of atherosclerosis and the occurrence of clinical events. PREVENT investigators. Circulation. 2000;102(13):1503-10.

10. Shal'nova S.A., Deev A.D., Balanova Y.A. Treatment of hypertension in high-risk patients. Monotherapy or combination? Lechasshii Vrach. 2016;7:17-23 (In Russ).

11. Boytsov S.A., Balanova Y.A., Shalnova S.A. Arterial hypertension among indivaiduals of 25-64 years old: prevalence, awareness, treatment and control. By the data from ECCD Cardiovascular Therapy and Prevention. 2014;13(4):4-14. (In Russ.) doi:10.15829/1728-8800-2014-4-4-14.

12. Davidovich I.M., Malay L.N., Kutishenko N.P. The analysis of long-term outcomes and adherent to treatment in patients after myocardial infarction: Khabarovsk register data. Clinician. 2017;11(1):36-44. (In Russ.) doi:10.17650/1818-8338-2016-10-4-36-44.

13. Truhan D.I., Pavlova T.V., Efremushkina A.A. Combined and monotherapy of hypertension in the PERSPEKTIVA program. Consilium Medicum. 2014;10:17-22 (In Russ.)

14. Morozova T. E., Yudina I. YU. Modern strategy to improve adherence to treatment of patients with arterial hypertension: fixed combinations of drugs. Consillium Medicum. 2010;22(1):22-8 (In Russ.)

15. Kobalava Zh.D., Tolkacheva V.V. Hyperglycemia in patients with acute coronary syndrome: contemporary state of the problem. A scientific statement from the American Heart Association diabetes committee. Kardiologiia. 2009;49(3):77-85 (In Russ.)

16. Polozkov V.I., Tarzimanova A.I. The new fixed combination of amlodipine and ramipril in the treatment of hypertension. Rational Pharmacotherapy in Cardiology. 2015;11(3):327-32 (In) doi:10.20996/1819-6446-2015-11-3-327-332.

17. Simonyi G. Benefits of Fixed Dose Combination of Ramipril/Amlodipine in Hypertensive Diabetic Patients: A Subgroup Analysis of RAMONA Trial. Chin Med J (Engl.). 2016;129(10):1224-8. doi:10.4103/0366-6999.181959.

18. Oganov R.G., Pogosova G.V. RELIPH - Regular Treatment and Prevention - The Key to Improvement of Situation with Cardiovascular Diseases in Russia: Results of a Russian Multicenter Study. Part III. Kardiologiia. 2008;48(4):46-53 (In Russ.)

19. Martsevich S.Y., Lukina Y.V., Kutishenko E.P. Study of patient’s adherence to treatment in metabolic syndrome, with the novel combination antihypertension compound of ramipril and amlodipine by the data of observational study GRANAT-1. Cardiovascular Therapy and Prevention. 2017;16(1):67-73. (In Russ.) doi:10.15829/1728-8800-2017-1-67-73.

20. Sega R, Corrao G, Bombelli M, et al. Blood pressure variability and organ damage in a general population: results from the PAMELA study (Pressioni Arteriose Monitorate E Loro Associazioni). Hypertension. 2002;39:710-4.

21. Lukina Yu.V., Martsevich S.Yu., Kutishenko N.P. State Research Centre for Preventive Medicine. Petrove The Moriscos-Green scale: the pros and cons of universal test, correction of mistakes. Rational Pharmacotherapy in Cardiology. 2016;12(1):63-5 (In Russ.) doi:10.20996/1819-6446-2016-12-1-63-65.

22. Order of the Ministry of Health of the Russian Federation dated December 20, 2012 No. 1175n "On approval of the procedure for prescribing and prescribing drugs, as well as prescription forms for drugs, the order of registration of these forms, their accounting and storage" [cited by Dec 10, 2018] Available from: http://base.garant.ru/70404898/ (In Russ.)


For citation:


Korennova O.Y., Podolnaya S.P., Prihodko E.P., Turusheva E.A., Starinskaya S.N., Вratishko I.A., Druk I.V. Antihypertensive Efficacy of Fixed Combination of Amlodipine and Ramipril in Patients with Arterial Hypertension and Very High Cardiovascular Risk. Rational Pharmacotherapy in Cardiology. 2018;14(6):840-845. https://doi.org/10.20996/1819-6446-2018-14-6-840-845

Views: 137


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)