Antihypertensive Efficacy Research Articles

Метаболічні та органопротекторні ефекти телмісартану в пацієнтів із гіпертонічною хворобою

У статті наведені дані дослідження впливу блокатора рецепторів 1-го типу до ангіотензину ІІ телмісартану на стан вуглеводного й ліпідного обміну, активність системного запалення низької градації, структурні показники лівого шлуночка та функціональний стан нирок у хворих на гіпертонічну хворобу. Отримані результати засвідчили високу антигіпертензивну ефективність телмісартану: у 73 % пацієнтів удалось досягти цільового рівня артеріального тиску при застосуванні монотерапії, при цьому у 37 % хворих нормалізація артеріального тиску відбулась уже через 2 тижні лікування. Органопротекторні властивості телмісартану в поєднанні з вираженими позитивними метаболічними властивостями, ймовірно, запобігають ураженню органів-мішеней та сприяють зниженню ризику серцево-судинних катастроф у хворих на гіпертонічну хворобу.

Гендерные особенности эффективности комбинированной антигипертензивной терапии у пациентов с артериальной гипертонией и ишемической болезнью сердца

Aim. To evaluate gender specifics of the efficacy of combination antihypertensive therapy by zofenopril and valsartan by QD or BID schedule in patients with arterial (AH) and stable coronary heart disease (CHD). Material and methods. Totally 98 men and 100 women were included with AH and CHD, who were randomized into 6 groups according to their gender differences and type of the therapy taken: I and IV groups (women and men) – zofenopril 30 mg/day in the morning, II and V groups (women and men) – valsartan 160 mg in the morning, III and VI groups (men and women) – valsartan 80 BID. All patients took β-adrenoblocker metoprolol succinate and diuretic hydrochlorothiazide. Follow-up period was 24 weeks. At the baseline and in 24 weeks, also ambulatory blood pressure monitoring performed (ABPM). Results. In men zofenopril intake and valsartan BID led to the achievement of target blood pressure values in most of the patients, as significant increase of the main ABPM parameters and profile normalization in 70% and 66,7% patients, resp. In women there were more patients with target BP, more significant positive changes in ABPM with “dipper” profile in 78,8% cases in the group of BID valsartan. Conclusion. In AH and stable CHD maximum antihypertensive efficacy in men was shown with ACE inhibitor zofenopril and ARA valsartan BID, in women – in valsartan, especially two times per day.

GW25-e2311 Antihypertensive Efficacy of Renal Denervation for Resistant Hypertension Evaluated by Ambulatory Blood Pressure Monitoring: A Systemic Review and Meta-Analysis

GW25-e2311 Antihypertensive Efficacy of Renal Denervation for Resistant Hypertension Evaluated by Ambulatory Blood Pressure Monitoring: A Systemic Review and Meta-Analysis

Association of common polymorphisms in β1-adrenergic receptor with antihypertensive response to carvedilol.

Marked interpatient variability exists in the blood pressure response to carvedilol, a nonselective β-blocker. Here we evaluated the influence of 4 common polymorphisms in genes of the β-adrenergic receptor on the antihypertensive efficacy of carvedilol in patients in a double-blinded monotherapy study. Eighty-seven subjects with uncomplicated essential hypertensive (49% men; age = 52.2 ± 11.1 years) from Jilin province of China were enrolled in the study, and 5 of them discontinued the treatment due to adverse effects. Both systolic and diastolic blood pressures (DBPs) were measured before and after 7 days of treatment with carvedilol (10 mg/d). Genotypes of the β1-adrenergic receptor (ADRB1 Ser49Gly and Arg389Gly) and β2-adrenergic receptor (ADRB2 Gly16Arg and Glu27Gln) were determined by polymerase chain reaction with restriction fragment length polymorphism. Patients homozygous for ADRB1 Arg389 had an approximately 4-fold greater reduction in DBPs than those homozygous for ADRB1 Gly389 (10.61 vs. 2.62 mm Hg, P = 0.013). The ADRB1 haplotype was also a significant predictor of response, as patients with the Gly49Arg389/Ser49Arg389 haplotype pair had a 5.7-fold greater reduction in DBPs than those homozygous for the Ser49Gly389 haplotype (16.11 vs. 2.83 mm Hg, P = 0.0055). An association was not found between ADRB2 polymorphism and carvedilol responsiveness in antihypertensive therapy. This study provides the first evidence to support that ADRB1 polymorphisms play an important role in the DBPs response to carvedilol treatment in patients with essential hypertension.

The efficacy of antihypertensive drugs in chronic intermittent hypoxia conditions.

Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CPAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.

Resistant Hypertension and Renal Denervation. Considerations on the Results of the Symplicity HTN-3 Trial

Resistant hypertension is undoubtedly a real clinical challenge, given that it increases cardiovascular events and has no effective treatment. Thus, it is easy to see why renal sympathetic denervation (RDN) has raised expectations among physicians treating patients with this serious disease. The SYMPLICITY HTN-1 trial was a proof-of-principle trial followed by the SYMPLICITY HTN-2 trial, which was a randomized unmasked trial that compared control patients and patients undergoing RDN therapy. Follow-up indicated significant and lasting reductions in blood pressure in the experimental group, thus raising expectations among physicians and patients. In fact, the European Society of Hypertension, the European Society of Cardiology, and an international panel of experts published position papers on RDN. In the same period, an RDN registry was set up in Europe with the participation of accredited centers. The registry has already collected data on more than 1500 patients. The recent publication of the SYMPLICITY HTN-3 trial, a single-blind, randomized, sham-controlled trial, confirmed that RDN is safe, but apparently lacks efficacy. Studies on RDN take the SYMPLICITY HTN-3 trial as the reference study and for this reason critics of the technique have suggested that the antihypertensive efficacy of RDN should be reconsidered in the light of its results. We consider that this viewpoint is questionable and analyze the reasons for our position. The SYMPLICITY HTN-3 trial followed an excellent design that randomized patients to RDN or a sham procedure. Analyses were based on the intention-to-treat principle. Thus, the trial included a control group to assess the possibility of a placebo effect. In fact, the SYMPLICITY HTN-1 and HTN-2 trials were accused of simply showing the placebo effect of the treatment on blood pressure. However, the conclusion that RDN lacks efficacy when compared with a sham procedure has been challenged. Firstly, there is insufficient evidence that blood pressure was stable during the RDN procedure in the SYMPLICITY HTN-3 trial in contrast to the SYMPLICITY HTN-1 and HTN-2 trials. The latter trials included long-term patients with high stable blood pressures

Comparative evaluation of zofenopril. Are the characteristics of angiotensin I converting enzyme inhibitors important for the practice?

The article provides an overview of the main comparative studies of antihypertensive efficacy and cardioprotective characteristics of zofenopril. We showed the information about the benefits of the drugs with higher tissue bioavailability preventing left ventricular hypertrophy and increasing its stiffness, because number of drugs possessing antiatherosclerotic and antiischaemic effects. The results of the studies, revealing the characteristics of action of these drugs class, will extend the capabilities of medical practitioners in the treatment of patients suffering from AH after acute myocardial infarction, associated with angina.

Triple combination therapy in hypertension: the antihypertensive efficacy of treatment with perindopril, amlodipine, and indapamide SR.

The blood pressure (BP) of most patients on antihypertensive monotherapy or bitherapy remains uncontrolled. Our study evaluated the efficacy of triple therapy with perindopril, amlodipine, and indapamide sustained release (SR) in patients with uncontrolled hypertension on previous antihypertensive therapy. This 4-month, multicenter, prospective, observational, open-label study included patients switched from previous antihypertensive therapy to triple therapy with perindopril, amlodipine, and indapamide SR. The main outcome was change in office BP from baseline to 4 months, as well as changes in 24-h ambulatory BP monitoring (ABPM) parameters in a subgroup of patients. Age was 62.8 ± 11.3 years in 6,088 patients (55 % were male). Office BP at baseline was 158.1 ± 13.0/92.6 ± 8.8 mmHg. By 4 months, office BP decreased by 26.7 ± 13.3/12.9 ± 9.4 mmHg (p < 0.001). ABPM was performed in 62 patients. In these patients, 24-h systolic BP decreased (from 138.7 ± 12.5 to 125.5 ± 12.8 mmHg), as did 24-h diastolic BP (from 77.5 ± 11.4 to 70.4 ± 8.7 mmHg) (both p < 0.0001). Heart rate remained unchanged. In patients previously on renin-angiotensin-aldosterone system (RAAS) inhibitor/amlodipine, 24-h ambulatory systolic and diastolic BP decreased from 136.9 ± 12.8 to 125.4 ± 13.3 mmHg (p = 0.0003) and from 76.3 ± 12.6 to 70.2 ± 9.5 mmHg (p = 0.0005). In those previously on RAAS inhibitor/hydrochlorothiazide, 24-h ambulatory systolic and diastolic BP decreased from 137.8 ± 12.7 to 122.7 ± 15.4 mmHg (p = 0.0039) and from 73.6 ± 9.4 to 65.7 ± 7.3 mmHg (p = 0.002). Most (74 and 80 %, respectively) patients reached target ABPM values (<130/80 mmHg). A triple combination of perindopril, amlodipine, and indapamide SR controlled BP effectively in hypertensive patients uncontrolled by previous antihypertensive monotherapy or bitherapy, including RAAS inhibitor/amlodipine or RAAS inhibitor/hydrochlorothiazide combinations.

Drug-drug interaction of losartan and glimepiride metabolism by recombinant microsome CYP2C9*1, 2C9*3, 2C9*13, and 2C9*16 in vitro.

Co-administration of anti-hypertension and anti-diabetic drugs is common in clinical settings. In this study, we characterized the drug-drug interactions of losartan (LOS) and glimepiride (GLP) using recombinant cytochrome P450 (CYP) 2C9 enzymes (CYP2C9*1, CYP2C9*3, CYP2C9*13, and CYP2C9*16). Metabolism of losartan by recombinant CYP2C9* 1, CYP2C9*3, CYP2C9*13, and CYP2C9* 16 was inhibited by glimepiride competitively with IC50 values of 0.669 ± 0.055 µM, 0.424 ± 0.032 µM, 2.557 ± 0.058 µM, and 0.667 ± 0.039 µM, respectively. The inhibitory effect of glimepiride on losartan metabolism by CYP2C9*13 was marginal. The apparent Ki value of glimepiride with CYP2C9*3 (0.0416 ± 0.0059 µM) was significantly lower than with CYP2C9*1 (0.1476 ± 0.0219 µM) and CYP2C9*16 (0.2671 ± 0.0456 µM). On the other hand, losartan weakly inhibited the hydroxylation of glimepiride by P450 2C9 enzymes competitively. The potencies for inhibition of glimepiride hydroxylation were determined to be CYP2C9*1~CYP2C9*3~CYP2C9*16 > CYP2C9*13 by 4 µM losartan. No significant inhibition was observed when 0.5 µM losartan was used. Given these results, the potential inhibition of losartan metabolism by CYP2C9*3, CYP2C9*13, and CYP2C9*16 in vivo by glimepiride deserves further investigation. These results may provide valuable information for optimizing the anti-hypertension efficacy of losartan when glimepiride is co-administered to patients.

Changes in 24 h ambulatory blood pressure and effects of angiotensin II receptor blockade during acute and prolonged high-altitude exposure: a randomized clinical trial.

Many hypertensive subjects travel to high altitudes, but little is known on ambulatory blood pressure (ABP) changes and antihypertensive drugs' efficacy under acute and prolonged exposure to hypobaric hypoxia. In particular, the efficacy of angiotensin receptor blockers in this condition is unknown. This may be clinically relevant considering that renin-angiotensin system activity changes at altitude. The HIGHCARE-HIMALAYA study assessed changes in 24 h ABP under acute and prolonged exposure to increasing altitude and blood pressure-lowering efficacy and safety of an angiotensin receptor blockade in this setting. Forty-seven healthy, normotensive lowlanders were randomized to telmisartan 80 mg or placebo in a double-blind, parallel group trial. Conventional and Ambulatory BPs were measured at baseline and on treatment: after 8 weeks at sea level, and under acute exposure to 3400 and 5400 m altitude, the latter upon arrival and after 12 days (Mt. Everest base camp). Blood samples were collected for plasma catecholamines, renin, angiotensin, and aldosterone. In both groups, exposure to increasing altitude was associated with: (i) significant progressive increases in conventional and 24 h blood pressure, persisting throughout the exposure to 5400 m; (ii) increased plasma noradrenaline and suppressed renin-angiotensin-aldosterone system. Telmisartan lowered 24 h ABP at the sea level and at 3400 m (between-group difference 4.0 mmHg, 95% CI: 2.2-9.5 mmHg), but not at 5400 m. Ambulatory blood pressure increases progressively with increasing altitude, remaining elevated after 3 weeks. An angiotensin receptor blockade maintains blood pressure-lowering efficacy at 3400 m but not at 5400 m.

Arterial stiffness as a cardiovascular events risk marker and possibilities for its downregulation by contemporary antihypertensive medications

Arterial blood pressure measured by Korotkov’s method is a non-valid predictor for possible cardiovascular events, which requires introduction of new methods of arterial hypertension diagnostics. Recently, the effect on arterial stiffness has become a very important characteristic of antihypertensive drugs overall efficacy. Evaluation of arterial stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to more precise cardiovascular risk stratification and reflects target organ damage and the effectiveness of antihypertensive treatment. In particular, pulse wave velocity exceeding 12 m/s is a significant risk factor of cardiovascular events. Arterial compliance can be determined by applanation tonometry, pulse wave shift at the carotid and femoral arteries, finger photoplethysmography, volume pulsoxymetry, echo-tracking, suprasystolic pulse waves recording method and cardio-ankle vascular index. Different effects of antihypertensive drugs on arterial stiffness at the same blood pressure reduction have been repeatedly shown. The article discusses the impact of the most commonly used antihypertensive drugs, including contemporary antihypertensive drugs combinations, on arterial stiffness. Effect of beta-blockers greatly varies depending on the characteristics of the drug, diuretics have neutral effect, calcium antagonists (especially amlodipine) decrease the pulse wave speed and arterial wall stiffness. Both angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (more data for enalapril, perindopril and valsartan) were effective in decreasing arterial wall stiffness. A significant reduction in arterial wall stiffness was mainly found if antihypertensive drugs combinations were used, especially the combination of calcium antagonists and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.

Efficacy and Safety of 30-Mg Fimasartan for the Treatment of Patients With Mild to Moderate Hypertension: An 8-Week, Multicenter, Randomized, Double-Blind, Phase III Clinical Study

PurposeThe standard 60-mg dose of fimasartan, a newly developed selective angiotensin II receptor blocker, is effective and safe for use in patients with mild to moderate hypertension. This study aimed to compare the efficacy and safety of low-dose (30 mg) fimasartan and placebo or valsartan (80 mg) for 8 weeks in patients with mild to moderate hypertension. MethodsIn this randomized trial, 293 patients (219 men; mean age, 54.24 [9.77] years) with mild to moderate hypertension were enrolled. After randomization to receive 30-mg fimasartan (n = 115), placebo (n = 117), or 80-mg valsartan (n = 61), the treatment dose was kept constant without dose escalation for 8 weeks. The primary end point was improvement in sitting diastolic blood pressure (SiDBP) from baseline to 8 weeks that was compared between treatments with low-dose fimasartan and placebo. The secondary end point was the overall efficacy and safety of low-dose fimasartan compared with that of placebo or valsartan. FindingsAt week 8, SiDBP changed by –9.93 (8.86) mm Hg in the fimasartan group and by –2.08 (9.47) mm Hg in the placebo group, which indicated significant antihypertensive efficacy (P < 0.0001). Efficacy was shown at week 4 as measured by SiDBP (–9.96 [7.73] vs –2.27 [7.85] mm Hg; P < 0.0001) or sitting systolic blood pressure (SiSBP) (–16.18 [14.44] vs –1.95 [13.48] mmHg; P < 0.0001) and at week 8 as determined by SiSBP (–15.35 [16.63] vs –2.30 [14.91] mm Hg; P < 0.0001). The fimasartan group exhibited more potent antihypertensive efficacy than the valsartan group both at week 4 (SiDBP, –9.96 [7.73] vs –6.53 [9.58] mm Hg [P = 0.0123]; SiSBP, –16.18 [14.4] vs –7.65 [12.89] mm Hg [P = 0.0002]) and at week 8 (SiDBP, –9.93 [8.86] vs –5.47 [8.96] mm Hg [P = 0.0021]; SiSBP, –15.35 [16.63] vs –7.49 [13.68] mm Hg [P = 0.0021]). Most treatment-emergent adverse events (TEAEs) were mild (89 of 95), and there were no serious TEAEs. The incidence of TEAEs was 19.1% in the fimasartan group, 22.6% in the placebo group, and 13.6% in the valsartan group, with no significant differences. ImplicationsLow-dose fimasartan (30 mg) was well tolerated during the study period with no significant TEAEs. Low-dose fimasartan had an effective blood pressure–lowering effect that was greater than that of 80-mg valsartan in patients with mild to moderate hypertension. ClinicalTrials.gov identifier: NCT01672476.

Genetic aspects of angiotensin converting enzyme inhibitors antihypertensive efficacy in patients with coronary artery disease and arterial hypertension

Genetic aspects of angiotensin converting enzyme inhibitors antihypertensive efficacy in patients with coronary artery disease and arterial hypertension

Alagebrium (ALT-711) improves the anti-hypertensive efficacy of nifedipine in diabetic-hypertensive rats.

Combining drugs with complementary mechanisms of action may contribute to improved hypertension control in diabetic patients. Advanced glycation end-product (AGE) breakers, a new class of candidate drugs targeting aging-related cardiovascular dysfunction, may be useful as novel adjuvant agents to improve the efficacy of diabetic hypertension (DH) treatment. This study evaluated the effects of alagebrium (ALT-711), an AGE breaker, combined with nifedipine, a Ca(2+) channel blocker, in a rat model of streptozotocin-induced DH. Compared with monotherapy, combination treatment significantly decreased systolic and diastolic blood pressure values, increased the pulse pressure, and decreased the coefficient of variation of the systolic blood pressure. Plasma biochemistry indicated that the concentrations of prostacyclin and nitric oxide were increased. Gene expression analysis showed significantly decreased prepro-endothelin-1expression in the aorta. These results reveal that alagebrium significantly improves the anti-hypertensive actions of nifedipine in a rat model of DH and suggest its potential use in the successful control of clinical DH.

Erratum to: 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)

Erratum to: 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)

0272: True antihypertensive efficacy of sequential nephron blockade in patients with resistant hypertension and confirmed medication adherence

We previously showed (Bobrie et al. J Hypertens 2012) that sequential-nephron blockade (SNB) was more effective than combined renin angiotensin system blockade (RB) for controlling BP in patients with resistant hypertension (RH). In this post-hoc analysis, we assessed medication adherence (MA) and its influence on the antihypertensive response to SNB/RB with a new combined scoring system. Pts with daytime ambulatory SBP/DBP (dASBP/dADBP) >135 and/or 85 mmHg, despite 4 week-treatment with irbesartan 300 mg+HCTZ 12.5 mg+amlodipine 5 mg, were randomised either to SNB (i.e.+spironolactone 25 mg, then +furosemide 20-40 mg, then +amiloride 5 mg, n=82) or RB (ramipril 5-10 mg, then bisoprolol 5-10 mg, RB group, n=82) for 12 weeks. MA was scored according to 4 criteria: (i) trough/peak plasma irbesartan (Irb) concentration (HPLC); (ii) urinary AcSDKP/creatinine ratio (UR) to evaluate ramipril intake; (iii) delay of last medication intake before visit (LMI); and (iv) pill counting (PC, %). One point of MA score was attributed to trough Irb >20ng/ml, UR >4nmol/mmol, LMI <24h and PC >80%. MA was defined as low (LMA, score <2), intermediate (IMA, score=3), and optimal (OMA, score=4). 82 pts among 164 had OMA (46 SNB and 36 RB); 52 pts had IMA (23 SNB and 29 RB); and 30 pts had LMA (13 SNB and 17 RB) (inter-groups difference: NS). LMA pts were younger than SMA pts (50±11 vs. 56±10 yrs, p<0.011). In OMA pts, the difference in dASBP/dADBP between SNB vs RB was significant (–11 [–17;–6]/–6 [–9;–2] mmHg, p<0.0001/p=0.0025), favoring SNB, whereas in LMA pts the significant difference between the two groups was no more observed (–6 [–19;7]/–1 [–10;7] mmHg, p=0.352/p=0.7096). The major BP lowering effect of SNB vs. RB observed in pts with OMA is lost in pts LMA. Combined methods for assessing MA allow determining the true efficacy of antihypertensive strategies in patients with RH. Reinforcement of MA in RH pts is deemed necessary.

The efficacy and safety of arotinolol combined with a different calcium channel blocker in the treatment of Chinese patients with essential hypertension: a one-year follow-up study

Background: Combined treatment of a calcium antagonist and α/β-adrenoreceptor blocker is expected to offer some advantages in the management of hypertension; however, their antihypertensive efficacy and safety remain relatively under-explored.Methods: The current study addresses the 24-h antihypertensive efficacy and safety of arotinolol combined with a different calcium channel blocker. One-hundred fifty-two patients were randomly divided into three groups: nifedipine, amlodipine and felodipine group. In each group, the antihypertensive treatment dose was 30 mg/d, 5 mg/d, 5 mg/d long acting nifedipine, amlodipine, felodipine plus 20 mg/d arotinolol, respectively. Blood pressure was measured in ABPM devices and mercury manometer.Results: The result showed that the effective rate of one year antihypertensive treatment of arotinolol combined with nifedipine was 51 of 53, significantly effective (p < 0.05) among three combinations. It also showed that there was no statistical significant difference (p > 0.05) in controlled rate of morning peak blood pressure between treatment of arotinolol combined with amlodipine and arotinolol combined with nifedipine, but there was a significant difference (p < 0.01) in controlled rate of morning peak blood pressure between arotinolol combined with nifedipine vs. felodipine and arotinolol combined with amlodipine vs. felodipine.Conclusions: The therapy approached of arotinolol combined with nifedipine or amlodipine could be effective and well-tolerated, and they can be used as the better chosen antihypertensive drug.

Effects of combining azilsartan medoxomil with amlodipine in patients with stage 2 hypertension

ObjectiveThe aim of the study was to measure the effects on blood pressure (BP) of the angiotensin receptor blocker azilsartan medoxomil, in 40 and 80 mg doses, combined with 5 mg of the calcium channel blocker amlodipine and to compare these effects with placebo plus amlodipine 5 mg.MethodsThis was a randomized, controlled, double-blind study of 6 weeks’ duration in 566 patients with stage 2 hypertension. The primary endpoint was 24-h systolic BP by ambulatory monitoring.ResultsThe mean age of the participants was 58 years; men and women were equally represented, and baseline 24-h BP (153–154/93 mmHg) and clinic BP (165–166/94–95 mmHg) were similar across the three treatment groups. After 6 weeks, 24-h BP decreased by 25/15 mmHg in both the azilsartan medoxomil/amlodipine 40/5 and 80/5 mg groups. These reductions were each greater than the 14/8 mmHg decrease with placebo plus amlodipine 5 mg (P≤0.001 for both comparisons). All treatments were well tolerated, and adverse events did not increase with the azilsartan medoxomil doses. Edema or fluid retention was less common in both combination groups (2.6 and 2.7%) than with placebo plus amlodipine (7.6%).ConclusionCoadministration of azilsartan medoxomil with amlodipine was well tolerated and led to meaningful additional BP reductions compared with placebo plus amlodipine.

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)

Our objective was to evaluate a triple-drug antihypertensive strategy for blood pressure control in patients with difficult-to-treat hypertension. The Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients (PIANIST) trial was an observational, 4-month, open-label study. A total of 4,731 patients at high or very high cardiovascular risk with hypertension that was not properly controlled [ , and for [corrected] whom study treatment (fixed-dose perindopril 10 mg/indapamide 2.5 mg + amlodipine 5 or 10 mg) was consistent with their existing therapeutic plan, were included. One-sample t tests and Chi-squared tests were performed to evaluate changes in blood pressure. Mean baseline office blood pressure (OBP) was 160.5 ± 13.3/93.8 ± 8.7 mmHg. After 4 months of therapy, OBP decreased by 28.3 ± 13.5/13.8 ± 9.4 to 132.2 ± 8.6/80.0 ± 6.6 mmHg (p < 0.0001). Blood pressure targets were reached by 72.0% of patients and by 81 and 91% of patients previously treated with an angiotensin-converting enzyme inhibitor/hydrochlorothiazide or an angiotensin receptor blocker/hydrochlorothiazide, respectively. Changes in OBP were 18.7 ± 8.3/9.7 ± 7.2 mmHg for grade 1 (n = 1,679), 30.4 ± 10.1/14.7 ± 8.6 mmHg for grade 2 (n = 2,397), and 45.4 ± 15.1/20.7 ± 12.1 mmHg for grade 3 patients (n = 655; all p < 0.0001). In patients who underwent ambulatory blood pressure monitoring (n = 104), 24-h mean blood pressure decreased from 147.4 ± 13.8/82.1 ± 11.9 to 122.6 ± 9.1/72.8 ± 7.4 mmHg (p < 0.0001). Ankle edema was infrequent (0.2% of patients). Triple combination perindopril/indapamide/amlodipine was effectively and safely administered to a large population of high- and very high-risk hypertensive patients who had not reached target OBP values with previous treatment.

Оценка антигипертензивной и кардиопротективной эффективности индапамида у больных с мягкой и умеренной артериальной гипертензией в режиме монотерапии

Цель исследования: изучение клинической и кардиопротективной эффективности 12-недельной монотерапии индапамидом у больных с мягкой и умеренной АГ. Материал и методы исследования. В исследование включены 33 больных эссенциальной гипертонией I–II стадии с артериальной гипертензией 1–2-й степени (мягкой и умеренной) (ESH/ESC 2007), мужского и женского полов, средний возраст которых составил 47,61 ± 9,62 года, средняя длительность заболевания — 6,21 ± 4,31 года. В качестве антигипертензивной терапии назначался индапамид в дозе 2,5 мг/сут. Эхокардиографическое исследование проводилось в соответствии с рекомендациями Американской ассоциации эхокардиографии в М- и В-режиме на аппарате ультразвуковой системы EnVisor C (philips, Голландия).Результаты исследования. В ходе 12-недельной монотерапии индапамидом отмечена высокая антигипертензивная эффективность препарата у больных с мягкой и умеренной АГ с достижением целевого уровня систолического и диастолического артериального давления у 75,6 % больных. Высокая антигипертензивная эффективность препарата также характеризовалась достоверной кардиопротекцией, обратным развитием гипертрофии левого желудочка у 52 % больных, снижением индекса массы миокарда левого желудочка на 10,86 %. Заключение. Индапамид в режиме монотерапии рекомендуется как антигипертензивный препарат, обладающий кардиопротективной эффективностью, для лечения больных с мягкой и умеренной артериальной гипертензией.