Nephroprotective strategy in the treatment of hypertension as a modern general medical problem
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01.01.2018 |
Podzolkov V.
Bragina A.
Ishina T.
Bragina G.
Vasilyeva L.
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Russian Journal of Cardiology |
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© 2018, Silicea-Poligraf. All rights reserved. The current population is characterized by a high prevalence of risk factors for the development of chronic kidney disease: hypertension, diabetes, obesity, metabolic syndrome, physical inactivity, smoking. The development of severe complications and a close connection with potentially fatal cardiovascular disorders make this disease a socially and economically significant problem. Treatment of chronic kidney disease in advanced stages belong to nephrologist duties. However, the success of preventive interventions depends on the time of their onset, which makes it relevant to identify the disease. The use of nephroprotective approaches by physicians of different specialties (general practitioners, cardiologists, gerontologists, nephrologists, endocrinologists) can significantly improve the prognosis of both those at risk of developing renal dysfunction and the existing disease. The review presents data on the clinical and laboratory efficacy of angiotensin-renin blocker use, as well as the combination of angiotensin II receptor blockers with calcium antagonists. Using the combination of the angiotensin II receptor blocker irbesartan and amlodipine as an example, we demonstrated the possibilities of nephroprotective therapy in patients with renal dysfunction.
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Antihypertensive efficacy of a triple fixed-dose combination of perindopril, indapamide, and amlodipine: Clinical effectiveness in ambulatory practice (results of the PETRA study)
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01.01.2018 |
Lishuta A.
Privalova Elena V.
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Kardiologiya |
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© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30% of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6% women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10/91.56±9.33 mm Hg, AH duration - 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47/11.41±9.90 mm Hg (p<0.0001). Doses of perindopril, indapamide, and amlodipine in combination at the final visit were 5/1.25/5, 10/2.5/5, and 10/2.5/10 mg. 24-hour ambulatory BP monitoring (ABPM) was carried out in 76 patients. Mean 24-hour BP lowed from mean 155.51±17.43/85.28±11.48 down to 134.63±12.51/77.83±8.99 mm Hg (p<0.0001). Clinically relevant improvement of a number of parameters of metabolism occurred after 3 months of the study (in particular, lowering of levels of total and low-density lipoprotein cholesterol [-8.6 and - 11.4%, respectively], triglycerides [-12,1%], fasting blood glucose [-6.6%]). Thus, results of the PETRA study confirmed 24-hour long antihypertensive efficacy of triple fixed dose combination of perindopril, indapamide, and amlodipine. This drug combination can present novel possibility in treatment of patients with AH who have not achieved target BP values on preceding dual combination therapy and fully corresponds with the single pill concept for formation of adherence to therapy.
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Fixed combinations in modern hypertension treatment algorithms
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01.01.2018 |
Sayutina E.
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Cardiovascular Therapy and Prevention (Russian Federation) |
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© 2018 Cardiovascular Therapy and Prevention. Modern appropriate treatment of hypertension involves the use of combination antihypertensive therapy. According to updated version of European Society of Cardiology 2018 guidelines, renin-angiotensinaldosterone system blockers must be used as first-line drugs, including in combination with hydrochlorothiazide. This article presents the algorithms for the management of patients with uncomplicated and asymptomatic (with target lesions) arterial hypertension. It also described the management of patients with concomitant cardiovascular, cerebrovascular, renal pathology and diabetes mellitus, and use of fixed combination of candesartan and hydrochlorothiazide. The article presents research data that confirmed not only the high antihypertensive efficacy of this combination, but also demonstrated its neutral metabolic profile, organ-protective effects, the ability to use in patients with chronic kidney disease, chronic heart failure, prior stroke, as well as high tolerability and treatment adherence.
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The fixed combination of lisinopril and indapamide: Optimization of cardioprotection in hypertensive patients
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01.01.2018 |
Podzolkov V.
Dragomiretskaya N.
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Arterial Hypertension (Russian Federation) |
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© 2018 All-Russian Public Organization Antihypertensive League. All Rights Reserved. The article presents current knowledge of pro-and antihypertensive mechanisms involved in the development of hypertension (HTN), and antihypertensive management strategies. Particular attention is paid to the angiotensin converting enzyme inhibitor lisinopril and thiazide-like diuretic indapamide. The mechanisms and effects are described. The paper discusses the results of multicenter randomized clinical trials, and the antihypertensive effects of lisinopril and indapamide and their impact on myocardial hypertrophy in hypertensive patients. The potential advantages of fixed combination of lisinopril and indapamide in the treatment of patients with HTN are also discussed.
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Blood pressure variability in hypertension associated with coronary heart disease: Prognostic value and management approaches
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01.01.2018 |
Ostroumova O.
Kochetkov A.
Guseva T.
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Arterial Hypertension (Russian Federation) |
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© 2018 All-Russian Public Organization Antihypertensive League. All rights reserved. The review discusses the role of blood pressure variability as a novel risk factor and its prognostic value in hypertension associated with the coronary artery disease. We discuss the modern approaches to calculation of blood pressure variability, its classification. The choice of antihypertensive drugs based on the blood pressure variability is discussed considering hypertension associated with coronary artery disease. We pay special attention to angiotensin enzyme converting inhibitors and calcium channel blockers, as well as their combinations. We present the evidence of the effects of perindopril and amlodipine and their fixed combination on the blood pressure variability and the decrease in cardiovascular risk in hypertension associated with coronary artery disease.
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Cognitive disorders and dementia in old patients with arterial hypertension
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01.01.2018 |
Ostroumova O.
Starodubova A.
Ostroumova T.
Chernyaeva M.
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Kardiologiya |
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© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article describes the definition of dementia, its diagnostic criteria, classification. Differences in the pathogenesis and clinical manifestations of different types of dementia are considered. The issues of interrelation of arterial hypertension and the risk of development of cognitive disorders and dementia in old and very old people are discussed in detail. Data on the effect of antihypertensive drugs of different groups on the risk of dementia and the state of cognitive functions are presented. The evidence base of dihydropyridine calcium antagonist amlodipine and thiazide-like diuretic indapamide-retard is discussed with respect to the prevention of dementia and cognitive decline and their beneficial effect on cognitive function in patients with arterial hypertension.
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