Hypertension and nephrology

[The importance of the increase in the use of fix dosage combination of calcium channel blockers in the domestic medical practice between 2007 and 2013]


MARCH 20, 2015

Hypertension and nephrology - 2015;19(01)

[Antihipertensive therapy in the complex treatment of diabetes mellitus, obesity and lipid metabolism disorder was discussed, which also means the fight against the emergence of cardiometabolic syndrome and chronic renal failure as well. Angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs), calcium channel blockers (CCB), b-blockers and thiazid diuretics with “A” level of evidence reduce cardiovascular morbidity and mortality. The main effect of CCBs is effective antihipertensive vasodilatation, which is the basis of anti-ischaemic, anti-anginal and antihipertensive agents for use in everyday practice. Based on the database of the National Health Insurance, we analyzed changes in the turnover of CCBs between 2007 and 2013 the examined period among CCBs ordered with TB support amlodipin is the most frequently used active ingredient. In December 2007 almost 75% of the prescriptions was amlodipin. That increased to 87,12% by December 2013. CCBs ordered in monotherapy not changed in the examined period, while combinations increased continuously Among CCBs between 2007 and 2013 the fix dosage combinations available with TB support are: statins (atorvastatin + amlodipin), ACE inhibitors (ramipril + felodipin, lisinopril + amlodipin, perindopril + amlodipin, ramipril + amlodipin, verapamil + trandolapril) and b-blockers (metoprolol + felodipin). Using the assigned CCB monotherapy decreased steadily during the study period, while the use of combination formulations induced gradually increased. At the end of the examined seven year period more than 40% of the prescribed boxes were CCB in fix combination. Use of the combination of amlodipin + perindopril increased while amlodipin + lisinopril continuously reduced. The use of the combination of felodipin + ramipril also decreased.]



Further articles in this publication

Hypertension and nephrology

[Role of activated cells and local inflammatory mechanisms in the development of hypertension]


[In the past decades an increasing attention has been paid regarding the possible role of the immune system in the development of hypertension. In vitro and in vivo animal experiments, as well as human studies provided evidence for the role of the innate and adaptive immune systems in the development of hypertension, especially in connection with the perivascular adipose tissue, heart and kidney. Inflammatory mediators, cytokines, reactive oxygen metabolites have not only local pro-hypertensive effecting the vasculature, but also influence the development of hypertension through other regulatory mechanisms, such as the central nervous system. These findings provide a new understanding of the development of hypertension, as well as offer new potential mechanisms that can be targeted with novel the - rapies.]

Hypertension and nephrology

[Monitoring of effectiveness of ramipril-amlodipine fixed combination in metabolic syndrome, a non-interventional trial (The RAMSES Study)]


[Hypertension is a cardiovascular risk factor. The 6th Cardiovascular Consensus Conference has recommended metabolic syndrome in high-risk category. In diabetic patients hypertension is observed in most cases. Aims: Monitoring the effectiveness and safety of the fix combination of ra - mipril/amlodipine therapy in patients with metabolic syndrome suffering from mild or moderate hypertension despite current antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved known metabolic syndrome patients (age over 18 years) with mild or mode - rate hypertension. Ramipril/amlodipine fixed combination (5/5, 5/10, 10/5 or, 10/10 mg) were administered or titrated in 3 visits, during the 6 months of trial period. The doses of the fixed combination drugs were determined individually during the visits by physicians involved in the study. The target blood pressure value was 140/90 mmHg and <140/85 mmHg in diabetic patients. Results: 63% of total patient (9,052) have fulfilled the protocol during the four month of trial (5,707 patients). The age of patients was 61.3±11.97 (mean±SD) years, 2.736 (47.9%) men and 2,971 (52.1%) women. 74.0% of total metabolic patients has reached target blood pressure at the end of 6th month (primary end point). The blood pressure has decreased significantly from 158.7±8.97/91.9±7.30 mmHg (1. visit) to 131.6±7.73/79.8±12.20 mmHg (-27.1±10.43 /12.1±13.38 mmHg) to the 6th month (3. visit) (p<0.0001). Patients with hypertension in metabolic syndrome have tolerated the various fixed combination of ramipril/amlodipine well. ]

Hypertension and nephrology

[Antihypertensives: Should They be Taken in the Morning or in the Evening? ]

KISS István, KÉKES Ede

Hypertension and nephrology

[Effects of peripheral resistance lowering and elevating beta-blockers on central blood pressure - nebivolol in focus]


[Central blood pressure, that is, blood pressure (BP) in the ascending aorta, is considered an important physiologic parameter as it reflects the hemodynamic relationship between the heart and the aorta, both in systole and in diastole. In the systolic phase, central BP represents the pressure against which the left ventricle has to eject blood during systolic contraction. Thus, central arterial pressure reflects both left ventricular stroke volume and afterload, defines cardiac work, and contributes to the development of left ventricular hypertrophy in hypertensive individuals. In the diastolic phase, central BP is a key determinant of the blood flow delivery to the myocardium. Despite the increasing knowledge regarding the importance of central blood pressure and the availability of non-invasive measurement technics it couldn’t spread in everyday clinical practice and rarely or not mentioned in the therapeutic guidelines. The different antihypertensiv drugs significantly differs based on their effects on central blood pressure particularly β-blockers. The so-called ’classical’ β-blockers have un - favourable effect on central blood pressure due to increasing peripherial vascular resistance. In the opposit the vasodilating β-blockers including nebivolol markedly decrease central blood pressure which could explain their beneficial effects.]

Hypertension and nephrology

[The selective imidazoline I agonist rilmenidine in the combined antihypertensive therapy]


[The rilmenidin as a imidazoline agonist drug strongly decreases the central simpathetic activity, renine release and the RAS activity. Because of these advantageous properties the peripheral vascular resistance falls and the blood pressure decreases. It is very useful especially in stress induced hypertension. The antihypertensive effects of ACE inhibitors and calciumantagonists are increased by rilmenidine. This drug decreases the inzuline resistance, it has a positive effect on the carbohydrate and fat metabolism, because it is useful as a complementary therapy in metabolic syndrome and of type II diabetes mellitus.]

All articles in the issue

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Lege Artis Medicinae

[Notes on the management of hypertension in chronic kidney disease ]


[The prevalence of hypertension among pa­tients with chronic kidney disease is high, reaching more than 80%. Hypertension is both one of the main causes and also the most common consequence of chronic kidney disease. It is also a main factor responsible for the high cardiovascular morbidity and mortality in this patient population. Blood pressure control can improve patient outcomes, lower cardiovascular risk and slow down the progression of kidney dis­ease, irrespective of the underlying cause. The optimal therapy should therefore focus not only on blood pressure reduction but also on renoprotection. Basic understanding of the renal pathophysiology in hypertension and renal effects of various medications is of paramount importance. In this review, we summarized cornerstones of the antihypertensive therapy in patients with chronic kidney disease. The management of patients receiving kidney replacement therapies, such as hemodialysis, peritoneal dialysis or transplanta­tion requires special knowledge and expe­rience, therefore it is not discussed here. The aim of this review was to allow non-nephrologist physicians to take care of their kidney patients with more confidence and effectiveness.]

LAM Extra for General Practicioners

[Advantages of fixed Combinations in the treatment of Hypertensive patients ]


[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]

Lege Artis Medicinae

[How can we reach more effective antihypertensive treatment in diabetic patients with hypertension?]


[Hypertension is the leading “silent killer” accounting for 10 million deaths worldwide. It frequently occures together with other metabolic risk factors, including type-2 diabetes mellitus and dyslipidemia augmenting the global cardiovascular risk of patients. Their treatment and reaching target blood pressure means a real challenge for practising physicians. According to the recent hypertension guidelines RAAS-inhibitors are the first choice agents which can be excellently combined with diuretics. RAAS-inhibitor based therapy frequently needs to be completed with Ca-antagonist to which statin should be added in the presence of metabolic risk factors. The benefits of amlodipin/atorvastatin fixed combination are multiple: both agents are capable to inhibit the progression of atherosclerosis and to reach blood pressure and LDL target values. In addition the well-known poor statin-adherence can be improved with fixed combination which can contribute to the reduction of risk of these high-risk subjects. ]

Lege Artis Medicinae

[Advantages of fixed combinations in the treatment of hypertensive patients]


[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]

Hypertension and nephrology

[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]