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The Possibilities of Single-Pill Combinations of Antihypertensive Drugs in Cerebroprotection: Focus on the Combination of Amlodipine with Ramipril

https://doi.org/10.20996/1819-6446-2020-06-10

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Abstract

Stroke remains one of the leading causes of death and disability both worldwide and in Russia. Acute cerebrovascular events have many risk factors, among them the most important is arterial hypertension (AH), which predisposes to the stroke development through the direct effect of increased hydrostatic blood pressure on the brain vascular system, followed by arterial remodeling and an increase in their stiffness. In addition, excessive blood pressure variability, activation of the tissue renin-angiotensin-aldosterone system, as well as target-organ damage - primarily the heart in the form of left ventricular hypertrophy, kidneys in the form of microalbuminuria and decrease in glomerular filtration rates. An additional risk factor for stroke is hyperuricemia, which is included in the current European and Russian guidelines for the management of AH as one of the new risk factors in patients with this disease. The state-of-the-art approach to antihypertensive therapy is the using of antihypertensive single-pill combinations, one of the frontline combinations in the absence of special clinical conditions is a combination of an angiotensin converting enzyme inhibitor and a calcium channel blocker. The reference drugs in both classes due to large body of evidence are ramipril and amlodipine, respectively. These drugs provide a high level of brain protection, not only due to the ultra-long and powerful antihypertensive action, but also through a unique potential in target-organ protection via left ventricular hypertrophy regression, antiatherosclerotic effects and improved endothelial function, renal protection, as well as the ability to decrease uric acid in the blood.

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, Russian Medical Academy of Continuous Professional Education.

Barrikadnaya ul. 2/1, Moscow, 125993.



S. V. Batyukina
Russian Medical Academy of Continuous Professional Education
Russian Federation

Svetlana V. Batyukina - Resident, Chair of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education.

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.



M. Yu. Nazranova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Marianna Yu. Nazranova - Student, Sechenov University.

Trubetskaya ul. 8-2, Moscow, 119991.



V. N. Butorov
Russian Medical Academy of Continuous Professional Education
Russian Federation

Vasilii N. Butorov - MD, PhD, Associate Professor, Chair of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education.

Barrikadnayaul. 2/1, Moscow, 125993.



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For citation:


Kochetkov A.I., Batyukina S.V., Ostroumova O.D., Nazranova M.Yu., Butorov V.N. The Possibilities of Single-Pill Combinations of Antihypertensive Drugs in Cerebroprotection: Focus on the Combination of Amlodipine with Ramipril. Rational Pharmacotherapy in Cardiology. 2020;16(3):487-497. (In Russ.) https://doi.org/10.20996/1819-6446-2020-06-10

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