Triple-combination in the treatment of hypertension

Czech version

Authors: J. Widimský jr.
Authors‘ workplace: III. interní klinika 1. LF UK a VFN v Praze, Centrum pro diagnostiku a léčbu hypertenze
Published in: Kardiol Rev Int Med 2014, 16(6): 449-453
Category: Cardiology Review

Overview

Combination of at least three antihypertensive drugs is needed in approximately 25–30% of all patients with hypertension. According to the current guidelines, the combination of a RAS blocker, calcium-channel blocker and diuretics is considered to be a combination of choice suitable for all severe forms of hypertension. The article introduces the first available fixed triple combination of perindopril-arginine, amlodipine and indapamide, which is a new option for hypertension. The article includes a brief description of characteristics, indications and clinical experience.

Keywords:
hypertension – combination therapy – perindopril – amlodipine – indapamide

Sources

1. Filipovský J, Widimský J Jr, Ceral J et al. Diagnostické a léčebné postupy u arteriální hypertenze, verze 2012: Doporučení České společnosti pro hypertenzi. Vnitř Lék 2012; 58: 785– 801.

2. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH// ESC Guidelines for the management of arterial hypertension. J Hypertens 2013; 31: 1281– 1357. doi: 10.1097/ 01.hjh.0000431740.32696.cc.

3. Wald DS, Law M, Morris JK et al. Combination therapy versus monotherapy in reducing blood pressure: meta‑analysis on 11,000 participants from 42 trials. Am J Med 2009; 122: 290– 300. doi: 10.1016/ j.amjmed.2008.09.038.

4. Gupta AK, Arshad S, Poulter NR. Compliance, safety and effectiveness of fixed dose combinations of antihypertensive agents: a meta‑analysis. Hypertension 2010; 55: 399– 407. doi: 10.1161/ HYPERTENSIONAHA.109.139816.

5. Ceral J, Habrdova V, Vorisek V et al. Difficult‑ to‑ control arterial hypertension or uncooperative patients? The assessment of serum antihypertensive drug levels to differentiate non‑responsiveness from non‑adherence to recommended therapy. Hypertens Res 2011; 34: 87– 90. doi: 10.1038/ hr.2010.183.

6. Strauch B, Petrák O, Zelinka T et al. Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis. J Hypertens 2013; 31: 2455– 2461. doi: 10.1097/ HJH.0b013e3283652c61.

7. Hess G, Hill J, Lau H et al. Medication utilization patterns and hypertension‑related expenditures among patiens who were switched from fixed‑dose to free‑ combination antihypertensive therapy. P T 2008, 33: 652– 665.

8. Corrao G, Nicotra F, Parodi A et al. Cardiovascular protection by initial and subsequent combination of antihypertensive druha in daily life practice. Hypertension 2011; 58: 566– 572. doi: 10.1161/ HYPERTENSIONAHA.111.177592.

9. Gradman AH, Parisé H, Lefebvre P et al. Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: a matched cohort study. Hypertension 2013; 61: 309– 318. doi: 10.1161/ HYPERTENSIONAHA.112.201566.

10. Makani H, Bangalore S, Romero J et al. Effect of renin‑angiotensin system blockade on calcium channel blocker associated peripheral oedema. Am J Med 2011; 124: 128– 135. doi: 10.1016/ j.amjmed.2010.08.007.

11. Fogari R, Zoppi A, Mugellini A et al. Effect of amlodipine, nifedipine GITS and indomethacin on angiotensin‑converting enzyme inhibitor induced cough: a randomized, placebo controlled, double‑blind study. Curr Ther Res 1999; 60: 121– 128. doi: 10.1016/ S0011‑ 393X(00)88520‑ 3.

12. Pall D. The antihypertensive efficacy of the perindopril‑ amlodipine‑ indapamide combination. J Hypertens 2012; 30 (Suppl A): e503.

13. Fox KM. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double‑blind, placebo‑ controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782– 788.

14. PROGRESS Collaborative Group. Randomised trial of perindopril‑based‑blood pressure lowering regimen among 6105 subjects with previous stroke or transiet ischemic attacks. Lancet 2001; 358: 1033– 1041.

15. Dahlöf B, Sever PS, Poulter NR et al. ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo‑ Scandinavian Cardiac Outcomes Trial‑ Blood Pressure Lowering Arm (ASCOT‑ BPLA). Lancet 2005; 366: 895– 906.

16. Poulter NR, Wedel H, Dahlöf B et al. Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo‑ Scandinavian Cardiac Outcomes Trial. Blood Pressure Lowering Arm (ASCOT‑ BPLA). Lancet 2005; 366: 907– 913.

17. Patel A, MacMahon S, Chalmers J et al. ADVANCE Collaborative Group. Effects of a fixed dose od perindopril and indapamid on macrovascular and microvascular outcomes in pts. with type 2 diabetes mellitus (The ADVANCE trial). Lancet 2007; 370, 829– 840.

18. Ferrari R. PREAMI Investigators. Effects of angiotensin‑converting enzyme inhibition with perindopril on left ventricular remodeling and clinical outcome: results of the randomized Perindopril and Remodeling in Elderly with Acute Myocardial Infarction (PREAMI) Study. Arch Intern Med 2006; 166: 659– 666.

19. Cleland JG, Tendera M, Adamus J et al. PEP‑ CHF Investigators. The perindopril in elderly people with chronic heart failure (PEP‑ CHF) study. Europ Heart J 2006; 27: 2338– 2345.

20. Williams B, Lacy PS, Thorn SM et al. Differential impact of blood pressure‑lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213– 1225.

21. Beckett NS, Peters R, Fletcher AE et al. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887– 1898. doi: 10.1056/ NEJMoa0801369.

22. Chalmers J, Arima H, Woodward M et al. Effects of combination of perindopril, indapamide and calcium channel blockers in patients with type 2 diabetes mellitus results from the action in diabetes and vascular disease: preterax and diamicron controlled evaluation (ADVANCE) trial. Hypertension 2014; 63: 259– 264. doi: 10.1161/ HYPERTENSIONAHA.113.02252.

23. Toth K. PIANISTS Investigators. Antihypertensive efficacy of triple‑ combination Perindopril‑ Indapamide plus Amlodipine in high risk hypertensives: results of the PIANIST study. Am J Cardiovasc Drugs 2014, 14: 137– 145. doi: 10.1007/ s40256‑ 014‑ 0067‑ 2.

24. SPC přípravku perindopril/ indapamid/ amlodipin, 2014.