Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Modern approaches to the choice of antihypertensive drugs are considered. Definitions of the "universal" combined antihypertensive therapy that can be effective in most hypertensive patients, regardless of their individual characteristics are discussed. Results of the most significant clinical trials evaluating the efficacy of combined antihypertensive therapy and the relevant provisions of up-to-date clinical recommendations are given as arguments.

About the Author

S. R. Gilyarevskiy
Russian Medical Academy of Postgraduate Education, Moscow
Russian Federation


1. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA doi:10.1001/jama.2013.284427 Published online December 18, 2013.

2. Jaffe MG, Lee GA, Young JD, et al. Improved blood pressure control associated with a large-scale hypertension program. JAMA 2013;310:699-705.

3. California Department of Managed Healthcare. California health plans vs. national top 10 performance. Right Care Initiative: Selected HEDIS Measures. 2012. Available at: Accessed November 11, 2013.

4. Department of Veterans Affairs, Veterans Health Administration, Office of Quality and Safety. 2009 VHA facility quality and safety report. Available at: Accessed November 11, 2013.

5. Report to the Appropriations Committee of the US House of Representatives in response to House Appropriations report No. 110-186, accompanying public law 110-161, the Consolidated Appropriations Act. 2008.

6. Department of Veterans Affairs, Veterans Health Administration, Office of Quality and Safety. 2010 VHA facility quality and safety report. Available at: Accessed November 11, 2013.

7. Dahlоf 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 randomised controlled trial. Lancet 2005; 366:895-906.

8. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008;359:2417-28.

9. Mancia G, De Backer G, Dominiczak A, et al. 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 2007;28:1462-536.

10. Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1982; 319:1165-8.

11. Messerli FH, Bangalore S. Diuretic-based regimens for obese patients? Lancet 2012;381:512-3.

12. Freis ED. Hemodynamics of hypertension. Physiol Rev 1960;40:27-54.

13. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-32.

14. Messerli FH, Garavaglia GE, Schmieder RE, et al. Disparate cardiovascular findings in men and women with essential hypertension. Ann Intern Med 1987;107:158-61.

15. McGavock JM, Victor RG, Unger RH, Szczepaniak LS. Adiposity of the heart, revisited. Ann Intern Med 2006;144:517-24.

16. Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002;347:305-13.

17. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88.

18. Barrett-Connor E, Khaw K. Is hypertension more benign when associated with obesity? Circulation 1985;72:53-60.

19. Goldbourt U, Holtzman E, Cohen-Mandelzweig L, Neufeld HN. Enhanced risk of coronary heart disease mortality in lean hypertensive men. Hypertension 1987;10:22-8.

20. Carman WJ, Barrett-Connor E, Sowers M, Khaw K. Hypertension/risk factors: higher risk of cardiovascular mortality among lean hypertensive individuals in Tecumesh, Michigan. Circulation 1994;89:703-11.

21. Uretsky S, Messerli FH, Bangalore S, et al. Obesity paradox in patients with hypertension and coronary artery disease. Am J Med 2007;120:863-70.

22. Weber MA, Neutel JM, Smith DHG. Contrasting clinical properties and exercise responses in obese and lean hypertensive patients. J Am Coll Cardiol 2001;37:169-74.

23. De Simone G, Wachtell K, Palmieri V, et al. Body build and risk of cardiovascular events in hypertension and left ventricular hypertrophy the LIFE (Losartan Intervention For Endpoint reduction in hypertension) study. Circulation 2005;111:1924-31.

24. Wassertheil-Smoller S, Fann C, Allman RM, et al. Relation of low body mass to death and stroke in the systolic hypertension in the elderly program. Arch Intern Med 2000;160:494-500.

25. Weber MA, Jamerson K, Bakris GL, et al. Effects of body size and hypertension treatments on cardiovascular event rates: subanalysis of the ACCOMPLISH randomised controlled trial. Lancet 2012;381:537-45.

26. Astashkin EI, Glaser MG. Lipotoxic effects in the heart, observed in obesity. Arterial Hypertension 2009; 15 (3) :335-41. Russian (Асташкин Е.И., Глезер М.Г. Липотоксические эффекты в сердце, наблюдаемые при ожирении. Артериальные Гипертензии 2009;15 (3):335-41).

27. Messerli FH, Bangalore S, Julius S. Risk/benefit assessment of beta-blockers and diuretics precludes their use for first-line therapy in hypertension. Circulation 2008;117:2706-15.

28. Bakris G, Molitch M, Hewkin A, et al. Differences in glucose tolerance between fixed-dose antihypertensive drug combinations in people with metabolic syndrome. Diabetes Care 2006;29: 2592-7.

29. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887-98.

30. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-97.

31. National Institute for Health and Clinical Excellence. Clinical management of primary hypertension in adults. August, 2011. Available at: live/13561/56008/56008.pdf (accessed Nov 20, 2012).

32. Kotchen T.A. Expanding role for combination drug therapy in the initial treatment of hypertension? Hypertension 2011;58:550-1.

33. McClellan KJ, Jarvis B. Lercanidipine: a review of its use in hypertension. Drugs 2000;60:1123-40.

34. Otero M. Manidipine-delapril combination in the management of hypertension. Vasc Health Risk Man- ag 2007;3: 25563.

35. Bang LM, Chapman TM, Goa KL. Lercanidipine: a review of its efficacy in the management of hypertension. Drugs2003;63:2449-72.

36. Meredith PA. Lercanidipine: a novel lipophilic dihydropyridine calciumantagonist with long duration of action and high vascular selectivity. Expert Opin Investig Drugs 1999;8:1043-62.

37. Epstein M. Lercanidipine: a novel dihydropyridine calcium-channel blocker. Heart Dis 2001;3:398-407.

38. Barrios V, Escobar C, de la Figuera M, et al. High doses of lercanidipine are better tolerated than other dihydropyridines in hypertensive patients with metabolic syndrome: results from the TOLERANCE study. Int J Clin Pract 2008;62:723-8.

39. Barrios V, Navarro A, Esteras A, et al. Antihypertensive efficacy andtolerability of lercanidipine in daily clinical practice. The ELYPSE Study. Blood Press 2002;11:95-100.

40. Barrios V, Escobar C, Navarro A, et al. Lercanidipine is an effective andwell tolerated antihypertensive drug regardless the cardiovascular riskprofile: The LAURA study. Int J Clin Pract 2006;60:1364-70.

41. James IG, Jones A, Davies P. A randomised, double-blind, double-dummy comparison of the efficacy and tolerability of lercanidipine tablets and losartan tablets in patients with mild to moderate essential hypertension. J Hum Hypertens 2002;16:605-10.

42. Leonetti G, Magnani B, Pessina AC, et al. Tolerability of long-termtreatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives. Am J Hypertens 2002;5:932-40.

43. Cherubini A, Fabris F, Ferrari E, et al. Comparative effects of lercanidipine, lacidipine, and nifedipine gastrointestinal therapeutic system on blood pressure and heart rate in elderly hypertensive patients: the ELderly and LErcanidipine (ELLE) study. Arch Gerontol Geriatr 2003;37:203-12.

44. Romito R, Pansini MI, Perticone F, et al. Comparative effect of lercanidipine, felodipine, and nifedipine GITS on blood pressure and heart rate in patients with mild to moderate arterial hypertension: the Lercanidipine in Adults (LEAD) Study. J Clin Hypertens 2003;5:249-53.

45. Soma MR, Natali M, Donetti E, et al. Effect of lercanidipine and its (R)enantiomer on atherosclrotic lesions induced in hypercholesterolemic rabbits. Br J Pharmacol 2003;125:1471-6.

46. Rachmani R, Levi Z, Zadok BS, et al. Losartan and lercanidipine attenuate low-density lipoprotein oxidation in patients with hypertension and type 2 diabetes mellitus: a randomized, prospective crossover study. Clin Pharmacol Ther 2002;72:302-7.

47. Canavesi M, Baldini N, Leonardi A, et al. In vitro inhibitory effect of lercanidipine on cholesterol accumulation and matrix metal- loproteinases secretion by macrophages. J Cardiovasc Pharmacol. 2004;44:416-22.

48. Robles NR, Ocon J, Gomez CF, et al. Lercanidipine in patients with chronic renal failure: the ZAFRA study. Ren Fail 2005;27:73-80.

49. Dalla Vestra M, Pozza G, Mosca A, et al. Effect of lercanidipinecompared with ramipril on albumin excretion rate in hypertensive type 2 diabetic patients with microalbuminuria: DIAL study (Diabete, Ipertensione, Albuminuria, Lercanidipina). Diabetes Nutr Metab 2004;17:259-66.

50. Viviani GL. Lercanidipine in type II diabetic patients with mild to moderate arterial hypertension. J Cardiovasc Pharmacol 2002;40: 133-9.

51. Robles NR, Pastor L, Manjon M, et al. Lercanidipine in diabetic patients with renal failure. Nefrologia 2004;24:338-43.

52. Acanfora D, Gheorghiade M, Trojano L, et al. A randomized, double- blind comparison of lercanidipine 10 and 20 mg in patients with stable effort angina: clinical evaluation of cardiac function by ambulatory ventricular scintigraphic monitoring. Am J Ther 2004;11:423-32.

53. Barrios V, Escobar C, Echarri R. Fixed combinations in the manage- ment of hypertension: perspectives on lercanidipine – enalapril. Vasc Health Risk Manag 2008;4:847-53.

54. Hair PI, Scott LJ, Perry CM. Fixed-dose combination lercanidipine/ enalapril. Drugs 2007;67:95-106.

55. Todd PA, Heel RC. Enalapril. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and congestive heart failure. Drugs 1986;31:198-248.

56. Minai K, Matsumoto T, Horie H, et al. Bradykinin stimulates the release of tissue plasminogen activator in human coronary circulation: effects of angiotensin-converting enzyme inhibitors. J Am Coll Cardiol 2001;37:1565-70.

57. Ravid M, Brosh D, Levi Z, et al. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1998;128:982-8.

58. Data on file. Efficacy and tolerability of a combination of lercanidipine and enalapril in patients with mild to moderate essential hypertension not adequately controlled by lercanidipine treatment (addon to lercanidipine) [CLP1-0018]. Milan, Italy: Recordati SpA; 2004.

59. Data on file. Efficacy and tolerability of a combination of lercanidipine and enalapril in patients with mild to moderate essential hypertension not adequately controlled by enalapril treatment (add-on to enalapril) [CLP1-0019]. Milan, Italy: Recordati Sp; 2004.

60. Estacio RO, Schrier RW. Antihypertensive therapy in type 2 diabetes: implications of the appropriate blood pressure control in diabetes (ABCD) trial. Am J Cardiol 1998;2:R1-R14.

61. Agrawal R, Marx A, Haller H. Efficacy and safety of lercanidipine versus hydrochlorothiazide as addon to enalapril in diabetic popula- tions with uncontrolled hypertension. J Hypertens 2006;24:185-92.

62. Puig JG, Calvo C, Luurila O, et al. Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebocontrolled, randomized, crossover study with four ABPM. J Hum Hypertens 2007;21:917-24.

63. Rump LC. Efficacy and tolerability of the fixed lercanidipine-enalapril combination in the treatment of patients with essential hypertension. Arzneimittelforschung 2010;60:124-30.


For citations:


Views: 703

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

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