EFFECTIVENESS OF PERINDOPRIL AND AMLODIPINE COMBINATION IN HYPERTENSIVES WITH COPD

Aim. To study efficacy of the standard combination of perindopril and amlodipine in target blood pressure levels achievement in COPD patients with AH.
Material and methods. Totally 28 patients included 17 men and 11 women, mean age 51,42±1,45 y.o. with the COPD II-III stage established, with arterial hypertension II stage, 2 grade. In treatment we used fixed antihypertensive combination of ACE inhibitor and calcium channel blocker amlodipine. The values of “office BP” were measured, with ambulatory blood pressure monitoring and spirometry data.
Results. After 30 days there was significant decrease of the mean “office BP” values, in 24 (85,7%) patients there was decrease of target BP. By ABPM data the decrease of mean clock-round, daytime and nocturnal BP values revealed. There was increase of the quantity of patients with physiological sleep pattern of BP from 5 to 12 (17,8% to 42,8%). Various dose regimens of perindopril/arginine combinations in 27 patients (96,4%) made it to achieve the BP level less than 140/90 mmHg. Long-term outcomes, tracked in the most of patients, showed good tolerability andhigh antihypertensive efficacy of the fixed perindopril and arginine combination.
Conclusion. The use of fixed ACE inhibitor and calcium channel blocker combination fulfilled effective, dose dependent BP decrease and let most of COPD and AH patients reach the target BP. The treatment was followed by significant decrease of mean, daytime and nocturnal levels of ABPM. With the treatment there was recovery of physiological circle-round BP with reliable decrease at night. The possible side effect — dry cough — was rare and did not lead to the decrease of spirography parameters.

1. Hurd SS, Lenfant C. COPD: good lung health is the key. Comment. Lancet. 2005; 366:1832-34.

2. WHO Key Facts COPD:http://www.who.int/mediacentre/factsheets/fs315/en/index.html.

3. Hunninghake DB. Cardiovascular Disease in Chronic Obstructive Pulmonary Disease. The Proceedings of the American Thoracic Society. 2005; 2: 44-9.

4. Crisafulli E, Costi S, Luppi F, et al. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax. 2008; 63: 487-92.

5. 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). J Hypertens. 2007; 25: 1105-87.

6. 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). European Heart Journal 2013; 34: 2159-219.

7. Zadionchenko VS, Adasheva TV, Fedorova IV, et al. Arterial hypertension and chronic obstructive pulmonary disease clinical-pathogenetic parallels and possibilities of therapy. Russ J Cardiol 2009; 6: 62-9. Russian (Задионченко В. С., Адашева Т. В., Федорова И. В., и др. Артериальная гипертония и хроническая обструктивная болезнь легких — клинико-патогенетические параллели и возможности терапии. Российский кардиологический журнал 2009; 6: 62-9).

8. Caroli NA, Rebrov AP. Arterial hypertension in patients with chronic obstructive pulmonary disease. Farmateka 2010; 18-19: 62-9. Russian (Кароли Н. А., Ребров А. П. Артериальная гипертензия у больных хронической обструктивной болезнью легких. Фарматека 2010; 18-19: 62-9).

9. Ciренко Ю. М. Артерiальна гiпертензiя та супутня патологiя / Ю. М. Сiренко. Донецьк: Издательский дом Заславский. 2010. 130 с.

10. Bova AA. Modern approaches to antihypertensive therapy in patients with arterial hypertension and chronic obstructive pulmonary disease. Medical news 2010; 1: 15-7. Russian (Бова А. А. Современные подходы к антигипертензивной терапии у больных артериальной гипертонией и хронической обструктивной болезнью легких. Медицинские новости 2010; 1: 15-7).

11. Diagnosis and treatment of hypertension. National clinical guidelines. Compendium. Ed. RG Oganov. 3rd edition. M.: Izd-vo “Silicea-Poligraf”, 2010. p. 491. Russian (Диагностика и лечение артериальной гипертензии. Национальные клинические рекомендации. Сборник. Под. ред. Р. Г. Оганова. 3-е издание. М.: Изд-во “Силицея-Полиграф”, 2010. c. 491).

12. Dahlof 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. Published online September 4, 2005.