Individualized approach to high-risk therapy: comparative assessment of fixed and separate combinations of antihypertensive and hypolipidemic drugs
Abstract
Background. Uncontrolled arterial hypertension in patients at high and very high cardiovascular risk remains a significant issue in modern medicine. Optimizing antihypertensive therapy using fixed or separate combinations of drugs represents a promising approach to improving blood pressure control and reducing the risk of cardiovascular complications.
Materials and methods. The study included 40 patients (men and women) with grade I–III hypertension according to the ESC/ESH classification (2018). The mean age was 51.52 ± 9.43 years, and the average disease duration was 8.52 ± 6.64 years. Patients were divided into two groups: one received a fixed combination (lisinopril/amlodipine/rosuvastatin), and the other received a separate combination (perindopril/amlodipine and rosuvastatin). Treatment lasted for 3 months. Effectiveness was assessed using 24-hour blood pressure monitoring, applanation tonometry, echocardiography, ultrasound examination of brachiocephalic arteries, and laboratory analyses (lipid profile, glucose level, uric acid, and creatinine).
Results. Both therapy regimens demonstrated high antihypertensive, organoprotective, and hypolipidemic effectiveness. However, patients receiving the fixed combination showed a more significant reduction in systolic and diastolic blood pressure, improved lipid profile, and decreased nighttime blood pressure variability. No adverse effects on metabolic profiles were observed.
Conclusion. The fixed combination of drugs demonstrated superiority over the separate combination regimen, providing better blood pressure control and lipid profile improvement. These findings highlight the importance of selecting optimal therapy regimens for high cardiovascular risk patients and confirm the efficacy of fixed combinations in this patient group.
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List of references
Acelajado M.C., Hughes Z.H., Oparil S., Calhoun D.A., Treatment of resistant and refractory hypertension, Circulation Research, 2019, 124, 07, 1061–1070, 10.1161/CIRCRESAHA.118.312156.
Cicero A.F.G., ALGhasab N.S., Tocci G., Desideri, G., Fiorini G., Fogacci F., Efficacy and safety of low-dose bisoprolol/hydrochlorothiazide combination for the treatment of hypertension: A systematic review and meta-analysis, Journal of Clinical Medicine, 2024, 13, 015, 4572, 10.3390/jcm13154572.
Dola´n E., Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients – an Anglo-Scandinavian cardiac outcomes trial substudy, Journal of Hypertension, 2009, 27, 04, 876–885, 10.1097/HJH.0b013e328322cd62.
Jamerson K., Shi V., Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients, New England Journal of Medicine, 2008.
Roth G.A., Global burden of cardiovascular diseases and risk factors, 1990–2019, Journal of the American College of Cardiology, 2020, 76, 025, 2982–3021, 10.1016/j.jacc.2020.11.010.
Sarzan´ı R., Laureti G., Gezzi A., Spannella F., Giulietti F., Single-pill fixed-dose drug combinations to reduce blood pressure: The right pill for the right patient, Therapeutic Advances in Chronic Disease, 2022, 13, 204062232211027, 10.1177/20406223221102754.
Schutte A.E., Srinivasapura N.Venkateshmurthy, Mohan S., Prabhakaran D., Hypertension in low- and middle-income countries, Circulation Research, 2021, 128, 07, 808–826, 10.1161/CIRCRESAHA.120.318729.
Sever P.S., The Anglo-Scandinavian Cardiac Outcomes Trial: Implications and further outcomes, Hypertension, 2012, 60, 02, 248–259, 10.1161/HYPERTENSIONAHA.111.187070.
Unge´r T., 2020 International Society of Hypertension global hypertension practice guidelines, Journal of Hypertension, 2020, 38, 06, 982–1004, 10.1097/HJH.0000000000002453.
Virani S.S., Heart disease and stroke statistics—2020 update: A report from the American Heart Association, Circulation, 2020, 141, 09, e139–e596, 10.1161/CIR.0000000000000757.
Wald N.J., Law M., Blood pressure meta-analysis highlights an implementation gap, The Lancet, 2022, 399, 010333, 1379–1380, 10.1016/S0140-6736(22)00192-1.
Sever P.S., Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations. Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm, Lancet, 2003, 361, 09364, 1149–1158, 10.1016/S0140-6736(03)12948-0.
Cequier A´ ., Tratamiento hipolipemiante en los pacientes con enfermedad cardiovascular de riesgo muy
elevado, REC CardioClinics, 2021, 56, 01, 39–48, 10.1016/j.rccl.2020.10.017.
Schutte A., Safety and effectiveness of combined antihypertensive and cholesterol-lowering therapy in high- and very high-risk patients, Circulation Clinical Trials, 2023.
Jamerson K., Shi V., Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients, New England Journal of Medicine, 2008.
European Society of Cardiology, Polypill strategy reduces cardiovascular events in heart attack patients, ESC Press Releases, Retrieved from https://www.escardio.org, 2023.
Poulter N.R., Role of blood pressure and other variables in the differential cardiovascular event rates noted in the ASCOT-BPLA, Lancet, 2009, 373, 09656, 1177–1183, 10.1016/S0140-6736(09)60316-8.
Unger T., Single-pill fixed-dose drug combinations for blood pressure and lipid lowering: Practice guidelines, Journal of Hypertension, 2020, 38, 06, 1046–1060, 10.1097/HJH.0000000000002390.
Sever P.S., Prevention of coronary heart disease and stroke in hypertensive patients with lipid abnormalities, Hypertension Journal, 2015.
Dolan E., Benefits of intensive antihypertensive therapy in preventing cardiovascular disease in high-risk patients, Hypertension, 2010.
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