Rational Pharmacotherapy in Cardiology

Advanced search

The Capabilities of Amlodipine/Lisinopril Single-Pill Combination in the Treatment of Newly Diagnosed Arterial Hypertension in a Middle-Aged Patient (Case Report)

Full Text:


Arterial hypertension (AH) is one of the most significant modifiable risk factors that increase cardiovascular morbidity and mortality worldwide, including Russia. The complex of structural and functional changes in the heart that occurs during AH consists not only in the formation of left ventricular (LV) myocardial hypertrophy, but also in the myocardial stiffness increasing due to collagen formation and cardiomyocytes apoptosis. These abnormalities are substrate for diastolic function disturbances, electrical myocardial instability and ischemia. The article provides a clinical case of amlodipine/lisinopril single-pill combination (A/L SPC) use in real clinical practice in a patient with stage II grade 2 newly diagnosed AH and its effect on blood pressure and echocardiographic myocardial fibrosis markers, including speckle tracking parameters The high antihypertensive efficacy of A/L SPC, a favorable effect on blood pressure circadian rhythm, as well as pronounced target-organ protective properties, in particular the ability to reduce LV and left atrial stiffness, were demonstrated. So, we conclude that A/L SPC improve the elastic properties of the left heart.

About the Authors

A. I. Kochetkov
Russian Medical Academy of Continuous Professional Education
Russian Federation

Alexey I. Kochetkov – MD, PhD, Associate Professor, Chair of Therapy and Polymorbid Pathology

Barrikadnaya ul. 2/1, Moscow, 125993

M. V. Lopukhina
E.O. Mukhin Municipal Clinical Hospital
Russian Federation

Mariya V. Lopukhina – MD, PhD, Head of Department of Functional Diagnostics

Federativnii pr. 17, Moscow, 111399

E. A. Kotaeva
S.P. Botkin Municipal Clinical Hospital
Russian Federation

Elena A. Kotaeva – MD, PhD, Head of Cardiology Department №5

Vtoroi Botkinskii pr. 5, Moscow, 125284

A. A. Kirichenko
Russian Medical Academy of Continuous Professional Education
Russian Federation

Andrey A. Kirichenko – MD, PhD, Professor, Chair of Therapy and Polymorbid Pathology

Barrikadnaya ul. 2/1, Moscow, 125993

O. D. Ostroumova
Russian Medical Academy of Continuous Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Olga D. Ostroumova – MD, PhD, Professor, Head of Chair of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov University

Barrikadnaya ul. 2/1, Moscow, 125993, 

Trubetskaya ul. 8-2, Moscow, 119991


1. Williams B., Mancia G., Spiering W., et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021-3104. DOI:10.1093/eurheartj/ehy339.

2. Chazova I.E., Zhernakova Y.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31 (In Russ.) DOI:10.26442/2075082X.2019.1.190179.

3. Pavlopoulos H., Nihoyannopoulos P. The constellation of hypertensive heart disease. Hellenic J Cardiol. 2008;49(2):92-9.

4. Dahlöf B., Sever P.S., Poulter N.R. et al.; ASCOT Investigators. 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 (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet. 2005;366:895-906. DOI:10.1016/S0140-6736(05)67185-1.

5. Jamerson K., Weber M.A., Bakris G.L., et al; ACCOMPLISH Trial Investigators. Benazepril plus Amlodipine or hydrochlorothiazide for Hypertension in High-Risk Patients. N Engl J Med. 2008;359(23):2417-28. DOI:10.1056/NEJMoa0806182.

6. Lang R.M., Badano L.P., Mor-Avi V., et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. DOI:10.1016/j.echo.2014.10.003.

7. Kahan T. The importance of myocardial fibrosis in hypertensive heart disease. J Hypertens. 2012;30(4):685-687. DOI:10.1097/HJH.0b013e328350e5db.

8. Jellis C., Martin J., Narula J., Marwick T.H. Assessment of nonischemic myocardial fibrosis. J Am Coll Cardiol. 2010;56(2):89-97. DOI:10.1016/j.jacc.2010.02.047.

9. Biering-Sørensen T., Biering-Sørensen S.R., Olsen F.J., et al. Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population: The Copenhagen City Heart Study. Circ Cardiovasc Imaging. 2017;10(3): pii: e005521. DOI:10.1161/CIRCIMAGING.116.005521.

10. Monaster S., Ahmad M., Braik A. Comparison between strain and strain rate in hypertensive patients with and without left ventricular hypertrophy: a speckle-tracking study. Menoufia Medical Journal. 2014;27(2):322.

11. Parati G., Stergiou G., O'Brien E., et al; European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32(7):1359-66. DOI:10.1097/HJH.0000000000000221.

12. Ersh I.R., Zaicev V.I., Romanchuk E.V., et al. Efficacy of long-term therapy with the Equator in patients with arterial hypertension in ambulatory conditions. Mezhdunarodnye Obzory: Klinicheskaya Praktika I Zdorov’e 2014;2(8):74-86. (In Russ.)

13. Donskaja A.A., Morozov S.N., Morozova E.A. Evaluation of the effect of monotherapy with the Equator on hemodynamic parameters in persons with arterial hypertension. Kardiovaskulyarnaya terapiya i profilaktika 2008;№ 6(4)Suppl.2:37 (In Russ.)

14. Maceira A.M., Mohiaddin R.H. Cardiovascular magnetic resonance in systemic hypertension. J Cardiovasc Magn Reson. 2012;14:28. DOI:10.1186/1532-429X-14-28.

15. de Simone G., Devereux R.B., Koren M.J., et al. Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation. 1996;93:259-65. DOI:10.1161/01.cir.93.2.259.

16. Melenovsky V., Borlaug B.A., Rosen B., et al. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol. 2007;49:198-207. DOI:10.1016/j.jacc.2006.08.050

17. Borlaug B.A., Lam C.S., Roger V.L., et al. Contractility and ventricular systolic stiffening in hypertensive heart disease. Insights into the pathogenesis of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2009;54:410-8. DOI:10.1016/j.jacc.2009.05.013.

18. Mizuguchi Y., Oishi Y., Miyoshi H., et al. The functional role of longitudinal, circumferential, and radial myocardial deformation for regulating the early impairment of left ventricular contraction and relaxation in patients with cardiovascular risk factors: a study with two-dimensional strain imaging. J Am Soc Echocardiogr. 2008;21:1138-44. DOI:10.1016/j.echo.2008.07.016.

19. Oishi Y., Miyoshi H., Iuchi A., et al. Negative impact of cardiovascular risk factors on left atrial and left ventricular function related to aortic stiffness-new application of 2-dimensional speckle-tracking echocardiography. Circ J. 2013;77:1490-8. DOI:10.1253/circj.CJ-12-1260.

20. Morris D.A., Gailani M., Vaz Pérez A., et al. Left atrial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr. 2011;24:651-62. DOI:10.1016/j.echo.2011.02.004.

21. Mondillo S., Cameli M., Caputo M.L., et al. Early detection of left atrial strain abnormalities by speckletracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011;24:898-908. DOI:10.1016/j.echo.2011.04.014.

22. Manaka M., Tanaka N., Takei Y., et al. Assessment of regional myocardial systolic function in hypertensive left ventricular hypertrophy using harmonic myocardial strain imaging. J Cardiol. 2005;45:53- 60.

23. Santos M., Shah A.M. Alterations in cardiac structure and function in hypertension. Curr Hypertens Rep. 2014;16(5):428. DOI:10.1007/s11906-014-0428-x.

24. Gosse P. Left ventricular hypertrophy-the problem and possible solutions. J Int Med Res. 2005;33 Suppl 1:3A-11A. DOI:10.1177/14732300050330S102.

25. Kang S.J., Lim H.S., Choi B.J., et al. Longitudinal strain and torsion assessed by two-dimensional speckle tracking correlate with the serum level of tissue inhibitor of matrix metalloproteinase-1, a marker of myocardial fibrosis, in patients with hypertension. J Am Soc Echocardiogr. 2008;21(8):907-11. DOI:10.1016/j.echo.2008.01.015.

26. Krämer J, Niemann M, Liu D et al. Two-dimensional speckle tracking as a non-invasive tool for identification of myocardial fibrosis in Fabry disease. Eur Heart J. 2013;34(21):1587-96. DOI:10.1093/eurheartj/eht098.

27. Ishizu T., Seo Y., Kameda Y., et al. Left ventricular strain and transmural distribution of structural remodeling in hypertensive heart disease. Hypertension. 2014;63(3):500-6. DOI:10.1161/HYPERTENSIONAHA.113.02149.

28. Ostroumova O.D., Kochetkov A.I. Effects of Amlodipine/Lisinopril Fixed-Dose Combination on Severity of Left Ventricular Hypertrophy and Parameters of Myocardial Stiffness in Patients With Hypertension Kardiologiia. 2016;56(11):27-37 (In Russ.) DOI:10.18565/cardio.2016.11.27-37.

29. Ostroumova O.D., Kochetkov A.I., Lopukhina M.V. Comparative Analysis of the Efficacy of FixedDose Combinations of Amlodipine/Lisinopril and Bisoprolol/Hydrochlorthiazide in Patients with Essential Arterial Hypertension Combined with Obesity and Overweight. Rational Pharmacotherapy in Cardiology. 2017;13(4):443-53 (In Russ.) DOI:10.20996/1819-6446-2017-13-4-443-453.

30. Ostroumova O.D., Kochetkov A.I., Kopchjonov I.I., Fomina V.M. Arterial Hypertension in the Presence of Overweight and Obesity. The Capabilities of Amlodipine and Lisinopril Combination. Part 1. Features of the Daily profile of Blood Pressure and Heart Damage as a Target Organ in Patients with Arterial Hypertension in Combination with Overweight and Obesity. Rational Pharmacotherapy in Cardiology. 2017;13(5):693-8 (In Russ.) DOI:10.20996/1819-6446-2017-13-5-693-698.

31. Ostroumova O.D., Kochetkov A.I., Kopchjonov I.I., Fomina V.M. Arterial Hypertension in the Presence of Overweight and Obesity. The Capabilities of Amlodipine and Lisinopril Combination. Part 2. Antihypertensive and Organoprotective Effects of Amlodipine/Lisinopril Fixed-Dose Combination in Patients with Arterial Hypertension in the Presence of Overweight and Obesity. Rational Pharmacotherapy in Cardiology. 2017;13(6):841-50 (In Russ.) DOI:10.20996/1819-6446-2017-13-6-841-850.

32. Ostroumova O.D., Kochetkov A.I. Fixed combination of amlodipine and lisinopril effectiveness in hypertensive smokers. Systemic Hypertension. 2018;15(1):23-31 (In Russ.) DOI:10.26442/2075-082X_15.1.23-31.

33. Brilla C.G., Funck R.C., Rupp H. Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation. 2000;102:1388-93. DOI:10.1161/01.CIR.102.12.1388.

34. Tsang T.S., Barnes M.E., Abhayaratna W.P., et al. Effects of quinapril on left atrial structural remodeling and arterial stiffness. Am J Cardiol. 2006;97:916-20. DOI:10.1016/j.amjcard.2005.09.143.

35. Diez J., Laviades C., Mayor G., et al. Increased serum concentrations of procollagen peptides in essential hypertension: relation to cardiac alterations. Circulation. 1995;91:1450-6. DOI:10.1161/01.CIR.91.5.1450.

36. Querejeta R., Varo N., Lopez B., et al. Serum carboxy-terminal propeptide of procollagen type I is a marker of myocardial fibrosis in hypertensive heart disease. Circulation. 2000;101(14):1729-35. DOI:10.1161/01.cir.101.14.1729.

37. Lopez B., Querejeta R., Varo N. Usefulness of serum carboxy-terminal propeptide of procollagen type I in assessment of the cardioreparative ability of antuhypertensive treatment in hypertensive patients. Circulation 2001;104:286-91. DOI:10.1161/01.CIR.104.3.286.

38. Varo N., Iraburu M., Varela M., et al. Chronic AT (1) blockade stimulates extracellular collagen type I degradation and reverses myocardial fibrosis in spontaneously hypertensive rats. Hypertension. 2000;35(6):1197-202. DOI:10.1161/01.hyp.35.6.1197.

39. Li H., Simon H., Bocan T., Peterson J. MMP/TIMP expression in spontaneously hypertensive heart failure rats: the effect of ACE- and MMP-I inhibition. Cardiovasc Res. 2000;46:298-306. DOI:10.1016/s0008-6363(00)00028-6.

40. Xing S.S., Tan H.W., Bi X.P., et al. Felodipine reduces cardiac expression of IL-18 and perivascular fibrosis in fructose-fed rats. Mol Med. 2008;14(7-8):395-402. DOI:10.2119/2008-00024.Xing.

41. Siddesha J.M., Valente A.J., Sakamuri S.S., et al. Acetylsalicylic acid inhibits IL-18-induced cardiac fibroblast migration through the induction of RECK. J Cell Physiol. 2014;229(7):845-55. DOI:10.1002/jcp.24511.

42. Matsumori A., Nunokawa Y., Sasayama S. Nifedipine inhibits activation of transcription factor NFkappaB. Life Sci. 2000;67:2655-61. DOI:10.1016/s0024-3205(00)00849-3.

43. Iwasaki Y., Asai M., Yoshida M., et al. Nilvadipine inhibits nuclear factor-kappaB-dependent transcription in hepatic cells. Clin. Chim. Acta. 2004;350:151-7. DOI:10.1016/j.cccn.2004.07.012.

44. Matsubara M., Hasegawa K. Effects of benidipine, a dihydropyridine-Ca2+ channel blocker, on expression of cytokine-induced adhesion molecules and chemoattractants in human aortic endothelial cells. Eur J Pharmacol. 2004;498:303-14. DOI:10.1016/j.ejphar.2004.07.086.


For citations:

Kochetkov A.I., Lopukhina M.V., Kotaeva E.A., Kirichenko A.A., Ostroumova O.D. The Capabilities of Amlodipine/Lisinopril Single-Pill Combination in the Treatment of Newly Diagnosed Arterial Hypertension in a Middle-Aged Patient (Case Report). Rational Pharmacotherapy in Cardiology. 2020;16(2):221-230. (In Russ.)

Views: 1002

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

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