LOW FIXED-DOSES COMBINATION PERINDOPRIL/INDAPAMIDE/AMLODIPINE -EFFECTS IN GRADE 2 HYPERTENSIVES NOT ADEQUATELY CONTROLLED

Abstract

Objective: Hypertension is worldwide spread, affects 40.41% of Romanians, and represents the leading cause of death. High blood pressure is associated with left ventricular hypertrophy and diastolic dysfunction. In 15–20% of patients with hypertension a combination of three drugs is needed to achieve blood pressure control, better in a single tablet with fixed doses, because the single-tablet formulation improves adherence, witch is low. The most rationale combinations appear to be a blocker of renin-angiotensin system, a calcium antagonist and a diuretic. The aim of our study was to evaluate the efficacy of low fixed-doses combination perindopril/indapamide/amlodipine 5/1.25/5 mg on blood pressure, left ventricular hypertrophy, and diastolic dysfunction in patients with primary grade 2 hypertension who did not reach the blood pressure goal (< 140/90 mmHg) with previous antihypertensive treatment. Design and method: We performed a prospective study, lasting 3 months, in which 46 treated, but not controlled, grade 2 hypertensives, medium age 55 ± 6 years, received in the evening, low fixed-doses combination perindopril/indapamide/amlodipine 5/1.25/5 mg. Office blood pressure was measured at baseline, 1 month and 3 months. Left ventricular echocardiographic parameters ware measured at baseline and after 3 months of treatment. We assessed patient general condition (well-being) as excellent, improved, appropriate or worse at baseline and after 3 months. Results: Blood pressure was significantly reduced by treatment, both systolic (164 ± 15 vs 138 ± 11 mmHg, p < 0.01) and diastolic (95 ± 9.5 vs 84 ± 7 mmHg, p < 0.01). LVMI was decreased from131.5 ± 19 to 111.3 ± 12.8 g/m2 (p < 0.001). E/A ratio increased from 0.84 ± 0.25 to 1.01 ± 0.14 (p < 0.002). After 3 months of therapy, patient well-being was rated as excellent in 71.74%, improved in 17.40%, appropriate in 10.86% and worse in 0%. Conclusions: Switching patients with uncontrolled grade 2 hypertension to low fixed-doses combination perindopril/indapamide/amlodipine 5/1.25/5 mg allowed to reach the target blood pressure value, with regression of cardiac hypertrophy and improvement in LV diastolic function. Treatment was well tolerated.