USE OF TRIPLE FIXED-DOSE ANTIHYPERTENSIVE DRUG COMBINATIONS IN RESISTANT HYPERTENSION – AMBULATORY BLOOD PRESSURE MONITORING RESULTS

Abstract

Objective: To check the efficacy of triple fixed-dose antihypertensive drug combination as continuation of separate drug regime during the follow-up at repeated ambulatory blood pressure monitoring (ABPM) in out-patient clinic. Design and method: Triple fixed dose antihypertensive combination of perindopril, amlodipine and indapamide in four different dosage combinations is now available for 4 years. During years 2015 to 2017 we analysed 23 patients with resistant hypertension (16 men, 7 women) who had repeated ABPM procedures with time gap from 3 to 24 months, replacing separate drugs. Results: Patients’ age was 60 ± 11 years (37–79 years). During 1st ABPM average antihypertensive drug use was 3.3 ± 1.4 drugs (1–7 drug groups) with 61% of patients already taking the 3 studied drug groups separately (ACE inhibitor, diuretic and calcium channel blocker), or in double fixed combinations. 26% of patients were taking additional antihypertensive drug groups (e.g. beta blockers, alpha blockers, centrally acting drugs, spironolactone). During 2nd ABPM triple fixed-dose perindopril /indapamide/amlodipine was prescribed (10/2.5/10 mg in 78%, 10/2.5/5 mg in a single patient – 4% and 5/1.25/5 mg in 18% of patients). Drug usage was intensified to 4.2 ± 1.3 antihypertensive drugs (3–7 drugs). Additional drug groups were prescribed in 22% of patients (beta blockers in 2, alpha blocker in 3 patients) and in 2 patients drug regimen could be simplified with discontinued drug groups (beta blocker and alpha blocker). Average blood pressure during ABPM lowered from 151/84 mmHg to 135/73 mmHg (16/11 mmHg, p < = 0.047/p < = 0.000), during awake period from 154/87 mmHg to 137/76 mmHg (p < = 0.001/p < = 0.030) and during sleep from 136/72 mmHg to 131/68 mmHg (NS/NS). During 2nd ABPM adequate blood pressure control was achieved in 35% of patients. Systolic blood pressure control improved from initial 4% of patients to 39% and for diastolic blood pressure from 43% to 74%, respectively. Conclusions: Intensive triple fixed dose antihypertensive drug combination, with prescription of additional antihypertensive drug groups when necessary, is effective way to simplify and improve control of resistant hypertension. Although blood pressure in our group of patients was significantly reduced, adequate blood pressure control still wasn’t achieved in a majority of patients.