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First fixed dose combination perindopril arginine-indapamide-amlodipine: new approach in combination therapy in hypertension


Authors: Jiří Widimský Jr
Authors‘ workplace: Centrum pro hypertenzi III. interní kliniky 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Vnitř Lék 2014; 60(9): 801-807
Category:

Overview

Use of fixed combination of antihypertensive drugs clearly improves compliance to the pharmacological therapy, control of hypertension and prognosis. Based on the current guidelines triple antihypertensive therapy with RAS-blocker, calcium channel blocker (CCB) and diuretic represents the standard and best option. The article introduces first and innovative fixed triple combination of perindopril arginine + indapamide + amlodipine (Triplixam®). This type of therapy is suitable for patients already treated with free combinations of three antihypertensive drugs or in those hypertensives with uncontrolled hypertension on two antihypertensive molecules (approx. 60% of all hypertensive population). Fixed combination of perindopril arginine + indapamid + amlodipin is indicated also in severe hypertension (approx. 30% of pts). Large clinical data from various morbidity-mortality studies related to each of these substances are discussed as well as basic pharmacological characteristics. Based on the results from ADVANCE-CCB study combination of perindopril arginine + indapamide + CCB decreases total mortality in hypertension by 28%. Another discussed study-PIANIST confirmed significant antihypertensive effect of Triplixam® on large sample of patients with various stages of hypertension. Triplixam® in addition to that has very good tolerance with low side effects profile, flexibility of the dosages and large body of evidence of positive impact on prognosis of hypertensive patients. Use of Triplixam® may improve control of hypertension in the Czech Republic.

Key words:
amlodipine – fixed combination – hypertension – indapamide – perindopril arginine – therapy


Sources

1. Filipovský J, Widimský J jr, Widimský J et al. Diagnostické a léčebné postupy u arteriální hypertenze – verze 2012. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2012; 58(10): 785–801.

2. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013, 31(7): 1281–1357.

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(3): 290–300.

4. Gupta AK, Arshad S, Poulter NR. Compliance, safety and effectiveness of fixed dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010; 55(2): 399–407.

5. Ceral J, Habrdová V, Voříšek 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(1): 87–90.

6. Strauch B, Petrák O, Widimský J jr et al. Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis. J Hypertens 2013; 31(12): 2455–2461.

7. Hess G, Hill J, Lau H et al. Medication Utilization Patterns and Hypertension-Related Expenditures among Patients Who Were Switched from Fixed-Dose To Free-Combination Antihypertensive Therapy. P T 2008, 33(11): 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(4): 566–72.

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(2): 309–318.

10. 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). EURopean trial on reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Lancet 2003; 362(9386): 782–788.

11. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358(9287): 1033–1041. Erratum in Lancet 2001; 358(9292): 1556 & Lancet 2002; 359(9323): 2120.

12. 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): a multicentre randomised controlled trial. Lancet 2005; 366(9489): 895–906.

13. 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(9489): 907–913.

14. Patel A et al (ADVANCE Collaborative Group). Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370 (9590): 829–840.

15. Ferrari R. Perindopril and Remodeling in Elderly with Acute Myocardial Infarction 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(6): 659–666.

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

17. 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(9): 1213–1225.

18. 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(18): 1887–1898.

19. Chalmers CH, 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(2): 259–264.

20. Toth K et al (PIANIST Investigators). Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). Am J Cardiovasc Drugs 2014; 14(2): 137–145. Erratum in Am J Cardiovasc Drugs 2014; 14(3):239.

21. Kjeldsen SE, Messerli FH, Chiang CE et al. Are fixed-dose combination antihypertensives suitable as first-line therapy? Curr Med Res Opin 2012; 28(10): 1685–1697.

22. Thoenes M, Neuberger HR, Volpe M et al. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 2010; 24(5): 336–344.

23. Makani H, Bangalore S, Romero J et al. Effect of renin-angiotensin system blockade on calcium channel blocker-associated peripheral edema. Am J Med 2011; 124(2): 128–135.

24. Fogari R, Zoppi A, Mugellini A et al. Effects of amlodipine, nifedipine GITS, and indomethacin on angiotensin-converting enzyme inhibitor-induced cough: A randomized, placebo-controlled, double-masked, crossover study. Curr Ther R 1999; 60(3): 121–128.

25. Pall D et al. The antihypertensive efficacy of the perindopril-amlodipine-indapamide combination. J Hypertens 2012; 30(Suppl A): e503.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 9

2014 Issue 9

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