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Pharmacoepidemiological Research of the Efficacy of Fixed Dose Combinations in the Treatment of Patients with Arterial Hypertension in Ambulatory Practice

https://doi.org/10.20996/1819-6446-2019-15-2-191-197

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Abstract

Aim. To study the pharmacoepidemiological features of the prescription of antihypertensive fixed dose combinations and their efficacy in hypertensive patients in the real outpatient practice in Vladivostok city.

Material and methods. Hypertensive patients aged 1 8 years and older (n=268) observed in Vladivostok polyclinics from October to December 2017 were included into the study. All patients did not have target blood pressure (BP) levels. The analysis of the medical prescriptions of antihypertensive fixed dose combinations in Vladivostok polyclinics was performed. Two-component (perindopril + amlodipine) or three-component (perindopril + amlodipine + indapamide) fixed dose combinations were prescribed by physician in accordance with instructions for medical use and their pharmacological characteristics. The study was non-interventional and included 3 visits for the initial examination, prescription and correction of therapy, considering its efficacy. All patients were determined for glomerular filtration rate using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Formula), changes in BP. Patients performed self-esteem on a 1 0-point visual analogue scale (VAS).

Results. Only 23.4% of patients reached target BP levels in the first month of observation, and 84.5% of patients after 3 months of observation. 30 (1 1.2%) patients had replacement with double antihypertensive fixed dose to triple combination combinations during the study. 68.6% of patients did not have a replacement for the initial prescribed antihypertensive fixed dose combinations due to the achievement of target BP. The number of patients with moderately and markedly reduced glomerular filtration rate was reduced significantly. Initially, the patients included into the study assessed health (according to adapted VAS) for 5.6±1.4 points, and after 3 months of follow-up - for 7.9±1.7 points.

Conclusion. The use of antihypertensive fixed dose combinations containing ACE inhibitor (perindopril), calcium channel blocker (amlodipine) and thiazide-like diuretic (indapamide) resulted in achievement of target BP levels in 84.5% of patients after 3 months of follow-up. Also, the use of double and triple fixed dose combinations had a nephroprotective effect, manifested in an increase in the number of patients ( + 19.3%) with a glomerular filtration rate more than 60 ml/min/1,73м2 and a positive effect on the patient's well-being.

About the Authors

E. V. Yakukhnaya
Pacific State Medical University; Far Eastern District Medical Center, Federal Medical-Biological Agency of Russia
Russian Federation

Elena V Yakukhnaya - MD, PhD, Associate Professor, Pacific State Medical University; Cardiologist, Far Eastern District Medical Center.

Prospect Ostryakova 2, Vladivostok, 690002; Prospect Stoletiya Vladivostoka 161, Vladivostok, 690002



E. V. Solyanik
Pacific State Medical University
Russian Federation

Elena V. Solyanik - MD, PhD, Professor.

Prospect Ostryakova 2, Vladivostok, 690002



V. V. Khitrina
Pacific State Medical University
Russian Federation

Viktoria V. Khitrina - MD, PhD, Associate Professor.

Prospect Ostryakova 2, Vladivostok, 690002



Yu. V. Kuznetsova
Far Eastern District Medical Center, Federal Medical-Biological Agency of Russia
Russian Federation

Yulia V. Kuznetsova - MD, Cardiologist, Far Eastern District Medical Center.

Prospect Stoletiya Vladivostoka 161, Vladivostok, 690002



References

1. Forouzanfar M.H., Liu P., Roth G.A. et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1 990-201 5. JAMA. 2017;31 7(2):1 65-82. doi:10.1001/jama.2016.19043.

2. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1 975 to 2015: a pooled analysis of 1 479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389:37-55. doi:10.1016/S0140-6736(16)31919-5.

3. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:21 59-21 9. doi:10.1093/eurheartj/eht151.

4. Boytsov S.A., Balanova Yu.A., Shalnova S.A. et al. Arterial hypertension among people aged 25-64: prevalence, awareness, treatment and control. based on research materials ESSE. Cardiovascular Therapy and Prevention. 2014;13(4):4-14 (In Russ.) doi:10.15829/1728-8800-2014-4-4-14.

5. Chazova I.E., Zhernakova Yu.V Recommendations for the diagnosis and treatment of arterial hypertension in 2018 - a word for European experts. Sistemnyye Gipertenzii. 2018;15(3):6-10 (In Russ.) doi:10.26442/2075-082X_2018.3.6-10.

6. Lip G.Y, Coca A., Kahan T, Boriani G. et al. Hypertension and cardiac arrhythmias: executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE). Eur Heart J Cardiovasc Pharmacother. 2017;3:235-50. doi:10.1093/ehjcvp/pvx019.

7. Yoon S.S., Carroll M.D., Fryar C.D. Hypertension prevalence and control among adults: United States, 201 1-2014. NCHS Data Brief. 2015;220:1 -8.

8. Martsevich S.U., Lukina Yu.V., Zagrebelnyy A.V. et al. Combined antihypertensive therapy in real clinical practice. Focus on fixed combination antihypertensive drugs. Rational Pharmacotherapy in Cardiology. 2017;1 3(3):323-29. (In Russ.) doi :10.20996/1819-6446-2017-13-3-323-329.

9. Nebieridze V N., Safaryan A.S., Vygodin VA. et al. Modern opportunities to achieve target blood pressure in patients with arterial hypertension in ambulatory practice: the results of the LEADER study. Rational Pharmacotherapy in Cardiology. 2018;14(1 ):12-20. (In Russ.) doi: 10.20996/1819-6446-2018-14-1-12-20.

10. Smirnov A.V., Shilov E.M., Dobronravov V.A. et. al. National recommendations. Chronic kidney disease: the basic principles of screening, diagnosis, prevention and treatment approaches. St. Petersburg: Levsha; 2013 (In Russ.)

11. Kobalava Z.D., Villevalde S.V, Borovkova N.Yu. et al. Prevalence of markers of chronic kidney disease in patients with arterial hypertension: results of an epidemiological study CHRONOGRAPH. Kardi-ologiia. 2017;57(10):39-44 (In Russ.) doi:10.18087/cardio.2017.10.10041.

12. . Go A.S., Chertow G.M., Fan D. et al. Chronic kidney disease and the risks of death, cardiovascular events and hospitalization. N Engl J Med. 2004;351:1 296-305. doi:10.1056/NEJMoa041031.

13. Yakukhnaya E.V., Solyanik E.V., Borodina I.A. et al. The effect of renal dysfunction on the quality of life indicators associated with the sensation of pain and general discomfort in hypertension. Kazansky Meditsinsky Zhurnal. 2018;99(4):556-61. (In Russ.)

14. Manjunath G., Tighiouart H., Ibrahim H. N. et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. Journal of the American College of Cardiology. 2003; 41 (1 ):47-55. doi:10.1016/S0735-1097(02)02663-3.

15. Drapkina O.M. on behalf of the researchers SYNERGY. Combined therapy of high-risk patients in real clinical practice. Research results SYNERGY. Part 1. Antihypertensive branch. Rational Pharmacotherapy in Cardiology 2017;1 3(2):1 55-63. (In Russ.) doi:10.20996/1819-6446-2017-13-2-155-163.

16. Leonova M.L., Shteinberg L.L., Belousov Yu.B. et al. Pharmacoepidemiology of arterial hypertension in Russia: analysis of adherence of doctors (according to the results of the PIFAGOR IV study). Sis-temnye Gipertenzii. 2015;12(1 ):19-25. (In Russ.)

17. Martsevich S.Yu., Lukina Yu.V., Kutishenko N.P. et al. Study of adherence to therapy in patients with metabolic syndrome with the example of a new combination antihypertensive drug ramipril and am-lodipine (based on the results of the observational study "GRANAT-1". Cardiovascular Therapy and Prevention. 2017;16(1 ):67-73. (In Russ.) doi:10.15829/1728-8800-2017-1-67-73.


For citation:


Yakukhnaya E.V., Solyanik E.V., Khitrina V.V., Kuznetsova Y.V. Pharmacoepidemiological Research of the Efficacy of Fixed Dose Combinations in the Treatment of Patients with Arterial Hypertension in Ambulatory Practice. Rational Pharmacotherapy in Cardiology. 2019;15(2):191-197. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-2-191-197

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