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]

BARNA István, GYURCSÁNYI András

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.]

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[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.]

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