Efficiency examination of antihypertensives fixed combination in patientes who had been on antihypertensive monotherapy

  • Nemanja Nikolić Poliklinika dr Nikolić
  • Tomislav Kostic
  • Marija Marinkovic
  • Mlađan Golubovic
  • Tamara Stojanovic
  • Milena Manojlovic
  • Igor Petkovic
Keywords: arterial hypertension, antihypertensives fixed combination,antihypertensive monotherapy

Abstract


Arterial hypertension is the condition where the blood pressure is higher than 140/90 mmHg. Along with i'ts complication,s it is  the leading factor for cardiovascular mortality. Artherial hypertension can be systolic, diastolic and combined. Diagnosis of artherial hypertension can not be set up based on the single measurement, it is already necessary to make measurements in different situations and environments.The aim of this study is antihypertensives fixed combination efficiency monitoring in patients with low or moderate hypertension in which antihypertensive monotherapy has not achieved adequate values of blood pressure. In this examination we have analyzed data of 395 patients, aged between 65 to80 years, with first and second grade  hypertension, who did not achieved adequate value of blood pressure with monotherapy. During 4 months of examination, patients were attended by 3 visits whereby their TA values were measured, and each of them has received antihypertensives fixed combination. The data obtained were processed by appropriate statistical analyzes. On the third visit to the doctor 69,8% patients have achieved blood pressure target value, and the blood pressure decreased for 16,6 /12,3% (р=0,000). Nonivasive 24h Holter monitoring showed significantly less oscillation in blood pressure values throughout the day, and also the patients were in a much smaller percentage forgotten to take therapy. During this study it was proved the efficiency of antihypertensive fixed combination considering that in a considerable number of patients blood pressure has been brought to the target values, there were no unwanted side effects, the patients  rarely forgot  to take the medicine, and there were significantly less oscilation in blood pressure on Holter monitoring.

References

Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, et al. Trends in the prevalence, awareness, treatment,and control of hypertension in the adult US population: data from the health examination surveys, 1960 to 1991. Hypertension 1995;26(1):60-9. [CrossRef] [PubMed]

Cheng J, Zhang W, Zhang X, Han F, Li X, He X, et al. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: A meta-analysis. JAMA Intern Med 2014;174(5):773-85 [CrossRef] [PubMed]

Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, 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-scan-dinavian cardiac outcomes trial-blood pressure lowering arm (ASCOT-BPLA): A multicentre randomi-sed controlled trial. Lancet 2005;366(9489):895-906. [CrossRef] [PubMed]

Heart Outcomes Prevention Evaluation Study Investi-gators. Effects of ramipril on cardiovascular and micro-vascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICRO-HOPE substudy. Lancet 2000;355(9200):253-9. [CrossRef] [PubMed]

Ilic S, Deljanin-Ilic M. Tretman arterijske hipertenzije. Acta Facultatis Medicinae Naissensis 2004;21(1):59-63.

Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M, et al. Prognostic significance of blood pressure and heart rate variabilities: The Ohasama study. Hypertension 2000 Nov;36(5):901-6. [CrossRef] [PubMed]

Lenfant C. Reflections on hypertension control rates: a message from the director of the National Heart, Lung, and Blood Institute. Arch Intern Med. 2002 Jan 28;162(2):131-2. [CrossRef] [PubMed]

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 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. [CrossRef] [PubMed]

Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC 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 2013;31:1281-357. [CrossRef] [PubMed]

Miranda RD, Mion D Jr, Rocha JC, Kohlmann O Jr, Gomes MA, Saraiva JF, et al. An 18-week, pros-pective, randomized, double‑blind, multicenter study of amlodipine/ramipril combination versus amlodipine monotherapy in the treatment of hypertension: The assessment of combination therapy of amlodipine/ ramipril (ATAR) study. Clin Ther 2008;30(9):1618-28. [CrossRef] [PubMed]

Tomcsányi J. Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix com-bination – A non-interventional trial (RAMONA study) (Hungarian). Hypertonia es Nephrologia 2013;17:34-8

Weir MR. Targeting mechanisms of hypertensive vascular disease with dual calcium channel and renin-angiotensin system blockade. J Hum Hypertens 2007; 21(10):770-9 [CrossRef] [PubMed]

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-104. [CrossRef] [PubMed]

Published
2021/03/17
Section
Original article