IMPROVEMENT OF AMLODIPINE CONTROL EFFICACY OVER HYPERTENSION USING FIXED COMBINATION OF PERINDOPRIL ARGININE AND AMLODIPINE

Aim. To evaluate possibilities of hypertension control improvement using fixed combination of perindopril arginine and amlodipine.
Material and methods. Totally 46 patients studied (25 men, 21 women of the age 53,6±4,3y.)with arterial hypertension 2-3 grade. All patients underwent ABPM with analysis of the following: mean 24-hour BP, velocity of morning SBP and DBP rise, BP variability of Ps BP (VPsBPd, VPsBPn).
The criteria of inclusion were insufficient control over hypertension while using free combinations of ACE inhibitor or angiotensin II receptor blockers and diuretic or calcium channel blocker. To control arterial hypertension all patients were prescribed the fixed combination of perindopril arginine/amlodipine it standard dosage 10/5 mg (Prestans, "Les Laboratories Servier", France) with further possible increase of dosage up to 10/10 mg.
Results. While receiving the therapy 84,7% patients reached "target" BP. Mean 24-hour SBP decreased from 139,24±1,8to 121,13+1,22 mmHg (p<0,05), DBP decreased from 84,51±2,08 to 73,14±1,4 (p<0,05), mean BP decreased from 103,07±1,56 to 87,66±1,13 (p<0,05). 24-hour variability of SBP significantly decreased from 15,28±0,72 to 10,21±0,42 (p<0,05), DBP from 13,46±0,72 to 10,72±0,31 (p<0,001). Values of VMR after the treatment also decreased. Before treatment VMR of SBP was 27±3,26 mmHg/hour, on therapy —
15,3±5,04 mmHg/hour, (p<0,01); the same for DBP — VMR decreased from 23,6±2,37 mmHg/hour to 11±1,62mmHg, (p<0,01).
Conclusion. The usage of combined perindopril arginine/amlodipine in patients with former uncontrolled arterial hypertension at the background of free chosen antihypertensive drugs combinations succeeded in the target BP values achievement in 84,7% cases. The reached control over BP was successful daily and during the night, as over variability of BP and velocity of morning BP rise. Usage of fixed combination of perindopril arginine/amlodipine was marked with good tolerability and high patients' compliance.

1. Diagnosis and treatment of arterial hypertension. Clinical guidelines. The Ministry of health of the Russian Federation. Moscow, 2013. http://www.gipertonik.ru/files/recommendation/ Recommendationsjiypertension.docx. Russian (Диагностика и лечение артериальной гипертонии. Клинические рекомендации. Министерство здравоохранения РФ. Москва, 2013. http://www.giperlonik.ru/files/recommendation/Recommendations_hypertension. docx).

2. Sirenko YN. Dihydropyridine calcium antagonists in a new reserve reduce the risk of complications of arterial hypertension. Hypertension 2010; 1(9): 47-52. Russian (Сиренко Ю.Н. Дигидропиридиновые антагонисты кальция — новый резерв снижения риска осложнений при артериальной гипертензии. Артериальная гипертензия 2010; 1(9): 47-52).

3. Palatini P. Role of elevated heart rate in the development of cardiovascular disease in hypertension. Hypertension 2011; 58:745-50.

4. Lewington S, Clarke R, Qizilbash N, et al. Age specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospectwe studies. Lancet 2002; 360:1903.

5. Meurin R The ASCOT trial: clarifying the role of ACE inhibition in the reduction of cardiovascular events in patients with hypertension. American Journal of Cardiovascular Drugs 2006; 6:327-34.

6. Karpov YuA, Deev AD, on behalf of the physicians participating in the program "PRORYV". Uncontrolled arterial hypertension — new opportunities in solving the problems of increasing the effectiveness of treatment. Cardiology 2012; 2: 29-35. Russian (Карпов Ю.А., ДеевА.Д. от имени врачей — участников программы "ПРОРЫВ". Неконтролируемая артериальная гипертония — новые возможности в решении проблемы повышения эффективности лечения. Кардиология 2012; 2:29-35).

7. 2013 ESH/ESC Guidelines forthe management of arterial hypertension. J Hypertens31:1281 -357.

8. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ЕОГ/ЕОК guidelines forthe 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 (28): 2159-219.

9. Gradman A, Basile J, Carter B, et al. Combination therapy in hypertension. Journal of the American Society of Hypertension 2010; 4:42-50.

10. Bahl VK, et al. Management of hypertension with the fixed combination of perindipril and amlodipine in daily clinical practice. Results from theSTRONG prospective, Observational, Multicenter Study. Cardiovasc Drug 2009; 9:136-42.

11. Girish MR et al. Blood pressure control of fixed dose, perindopril/ amlodipine combination treatment in hypertensive patients uncontrolled on monotherapy or on two drug combination therapy. ESH 2010.

12. Kjeldsen S, Jamerson K, Bakris G, et al. Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: the ACCOMPLISH study. Blood Pressure 2008; 17:7-17.