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Hypertension and nephrology

MAY 10, 2019

[One-year persistence of fixed-dose combinations of angiotensin-converting enzyme inhibitor and calcium channel blocker in hypertensive patients]

SIMONYI Gábor, FERENCI Tamás, FINTA Ervin, IGAZ Iván, BALOGH Sándor, GASPARICS Roland, MEDVEGY Mihály

[Introduction: The most recent European guidelines for the treatment of hypertension suggest the use of renin-angiotensin-aldosterone system antagonists (RAAS inhibitors) and calcium channel blockers (CCBs) or diuretics fixed-dose combinations (FDCs) as the first therapeutic option. In antihypertensive therapy, the patient’s adherence is one of the most important factors in reducing unwanted cardiovascular events. Aim: Our aim was to assess the one-year persistence of angiotensin-converting enzyme inhibitor (ACEI) and CCB FDCs in hypertensive patients. Method: Authors have analysed the prescription database of the National Health Insurance Fund in Hungary on pharmacy claims between October 1, 2012 and September 30, 2013. Those patients were identified who filled prescriptions for FDCs of ACEI and CCBs prescribed for the first time for hypertensive patients and who had not re ceived similar drugs during the year before. Apparatus of survival analysis was used, where ‘survival’ was the time to abandon the medication. Results: 124,388 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinua tion in patients with ramipril/amlodipine FDC was 54% (HR = 1.00, reference), perindopril/amlodipine 47% (HR = 1.30, p<0.0001), lisinopril/amlodipine 36% (HR = 1.79, p<0.0001), ramipril/felodipine 26% (HR = 2.28, p<0.0001) and trandolapril/verapamil 12% (HR = 4.13, p<0.0001). The average survival time of drug limited to 360 days was 270.2 days for ramipril/amlodipine FDC, 242.7 days for perindopril/amlodipine FDC, 211.2 days for lisinopril/amlodipine FDC, 186.3 days for ramipril/felodipine FDC and 125.7 days for trandolapril/verapamil FDC. Conclusions: The authors demonstrated that the one-year persistence of ACEI/CCB FDCs was significantly different in hypertensive patients. Ramipril/amlodipine FDC was more advantageous for patient adherence.]

Lege Artis Medicinae

DECEMBER 10, 2018

[Modalities of the therapy of patients with high cardiovascular risk]

FARSANG Csaba

[International and Hungarian guidelines emphasize the need of the combinations in the therapy of hypertension. Single pill combinations (SPC) are preferred. The importance of the treatment reducing cardiovascular risk is underlined by the fact that in most hypertensive patients other cardiovascular risk factors, among them most frequently dyslipidemia is present. In addition to antihypertensive drugs these patients should be treated also with those decreasing plasma lipids. Adherence / persistence to therapy of patients is greatly improved by the use of single pill combinations. Today we also have SPCs decreasing both, blood pressure and plasma lipids. Among them there is the combination containing amlodipine and atorvastatin. Several international and Hungarian clinical studies have been conducted. Results of these investigations have been described in several publications. In this paper I summarise the most important results of some of these studies. ]

Hypertension and nephrology

SEPTEMBER 12, 2018

[More than bodyguard? The ramipril/amlodipine FDC effect on their whole blood pressure spectrum]

SIMONYI Gábor, ZSUZSA Pál, GENCSIOVA Kristína, FINTA Ervin

[Hypertension is a significant cardiovascular risk factor. Effective treatment of hypertension contributes to avoiding the risk of later cardiovascular complications. Rapid access to blood pressure targets is also important in new untreated hypertensive patients. In the new ESH/ESC Hypertension Recommendation - during the initiation of antihypertensive therapy - the immediate introduction of drug combinations is explicitly recommended. In our retrospective data collection study we studied the effect of the ramipril/amlodipine fixed combination on the 24-hour brachial and central blood pressure parameters of the fresh hypertensives.]

Hypertension and nephrology

APRIL 08, 2017

[Efficacy of a fixed-dose association of amlodipine and lisinopril in grade II and III hypertensive patients]

JOÃO Maldonado, TEIMO Pereira, MARGARIDA Carvalho

[We conducted an observational study, with ambulatory blood pressure monitoring (ABPM), to evaluate the efficacy of a fixed-dose combination of Amlodipine (5 mg) and Lisinopril (20 mg) in grade II and III hypertensive patients, over an 8 week intervention period. Thirty non-medicated hypertensive patients were enrolled, 36% female, with a mean age of 52.44±11.54 years, a body mass index of 28.73±4.54 kg/m2, and brachial office systolic (SBP) and diastolic (DBP) blood pressure of 174.43±15.06 mmHg and 102.83±10.67 mmHg, respectively. All patients performed a 24 hours ABPM at baseline and after a treatment period of 8 weeks with the fixed-dose association. Brachial office blood pressure and routine blood and urine samples were also obtained in both moments. A significant reduction in blood pressure was observed after the treatment with the fixed-dose association. The proportion of patients with controlled ambulatory blood pressure after the treatment was 69%, considering the normalization of the systolic and diastolic ambulatory pressures over the daytime, nighttime and 24 hours. Considering the brachial office blood pressures, the proportion of controlled hypertensive patients reached 79%. A significant improvement was also seen in microalbuminuria (reduction of 37.40 mg/24h; IC: 2.82-71.97; p=0.035) and fasting glycaemia (reduction of 11.53 mg/dl; IC: 3.46-19.61; p=0.007). No side effects were reported during the 8 week treatment period. The treatment of grade II and III hypertensive patients with a fixed-dose association of Amlodipine (5 mg) and Lisinopril (20 mg) during 8 weeks is effective controlling blood pressure. Furthermore, evidences indicate that the efficacy of the association is achieved quickly, safely and with good tolerability.]

Hypertension and nephrology

APRIL 10, 2017

[Poor medication adherence - Whose responsibility? the physician and/or the patients?]

SIMONYI Gábor

[Hypertension is one of the most frequent disease in Hungary and one of the most important cardiovascular risk factor. Treating to target, significantly lower the risk of coronary artery disease, stroke chronic renal disease and mortality too. In treating of hypertension after life style therapy drug treatment has an essential role. In essential hypertension patients need to treat to the end of their life. Therefore patient adherence plays a significant role in the success of the treatment. The complexity of medication regimen and characteristic of drug class, age and gender all have influence the patient adherence. In Hungary the one year persistence of ramipril/amlodipine fixed dose combination was 20 percent higher than ramipril amlodipine free combination and ramipril/amlodipine fixed dose combination was 25 percent higher than ramipril/hydrochlorothiazide fixed dose combination.]

Hypertension and nephrology

FEBRUARY 10, 2017

[Our clinical practice with perindopril/indapamide/amlodipine triple fixed-dose combination]

BATTYÁNYI Bertalan

[Notwithstanding the abundance of pharmacotherapeutic options available, the rate of optimal blood pressure control may be estimated as low as 20 to 40 per cent throughout Europe. The underlying causes of this include, among others, the substantial impact of using free combinations of several antihypertensive - this practice results in rather poor patient adherence. Fixed-dose dual combinations have been introduced just about two decades ago, and their popularity has been increasing progressively since then. Nevertheless, in a considerable proportion (>30%) of patients, achieving optimal blood pressure control requires treatment with at least three antihypertensive acting on different targets. Accordingly, a rational demand has grown for triple-fixed combinations. In Hungary, the fixed combination of perindopril (an ACEI), indapamide (a thiazide-like diuretic), and amlodipine (a calcium channel-blocker) has been available since last year. Our experience with this product shows, as confirmed by ABPM studies, that its routine use in hypertensive patients with cardiological comorbidities improves patient compliance, thereby enhancing also long-term blood pressure control.]

Hypertension and nephrology

SEPTEMBER 10, 2016

[A new, effective tool in the treatment of hypertension in light of the available evidence]

MASSZI Gabrilella

[Hypertension is important even in the group of common diseases. Cardiovascular mortality could be significantly reduced if high blood pressure could not only be treated, but controlled as well. The newly introduced fixed combination perindopril-amlodipin-indapamide medication could be a good tool for genereal practitioners, specialists in internal medicine and cardiologists. Combined treatment with the ACE inhibitor perindopril, the new vasorelaxant type diuretic indapamide and the third generation type Ca-chanel blocker amlodipin is effective in reducing blood pressure. Besides effectivity the organ protective pleiotrop qualities (cardioprotective, plakk stabilising, antiatherosclerotic, antithrombotic, stroke preventive, endothel dysfunction reducing, renal protetcion granting) provide a long lasting beneficial impact on life expectancy and a better quality of life to the patients. If we choose the right dosage, we could raise the compliance level of patients resulting in excellent degrees of compliance. In our article we wanted to draw attention to the major evidencies which are the best acknowledgements of this triple combination although we didn’t explore all avenues.]

Hypertension and nephrology

APRIL 10, 2016

[Initiation of antihipertensive therapy with fix combinations, focusing on perindopril, amlodipine and indapamide]

FARSANG Csaba

[Early clinical studies proved that most hypertensive patients (>70%) need drug combinations to reach the target blood pressure. We should combine two or three - sometimes more - drugs from different antihypertensive classes for quicker normalisation of blood pressure and to reduce incidence and severity of hypertensive complications. Several international and Hungarian (MHT 2015) guidelines emphasize the advantages of fix combinations against free combinations. Most frequently used combinations contain ACEi + calcium antagonist, or ACEi + diuretic. From them I will focus on the perindopril + amlodipine or perindopril + indapamide combinations. If we do not reach target blood pressure, triple fix combinations (e.g. perindopril + amlodipine + indapamide) can also be used. Now there are fix combinations of different strengths, therefore we may start the therapy with these fix combinations according to patients’ characteristics (e.g. age, complications, concomitant diseases).]