Combination Of Perindopril Research Articles

IMPACT OF OBESITY ON THE EFFECTIVENESS OF TREATMENT WITH A SINGLE-PILL COMBINATION OF PERINDOPRIL ARGININE/INDAPAMIDE. DATA ANALYSIS OF THE RUSSIAN PROGRAM, FORSAGE

Objective:Efficacy of a single-pill combination of perindopril arginine/indapamide (Per/Ind) at full dose (10 mg/2.5 mg) in patients with arterial hypertension, depending on the initial body mass index (BMI).Design and method:1963 treated, uncontrolled hypertensive patients from the FORSAGE study (2

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

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.

ADDITIONAL ANGIOPROTECTION AND METAbOLIC DISORDERS CORRECTION IN TREATMENT OF ARTERIAL HYPERTENSION PATIENTS REACHED TARGET bLOOD PRESSURE LEVELS, WITH FIxED COMbINATION OF PERINDOPRIL AND INDAPAMIDE

Aim. Evaluation of the ability of fixed combination of perindopril and indapamide (Noliprel Bi Forte) to achieve additional angioprotection in patients with arterial hypertension already reached target blood pressure (BP) at previous antihypertension therapy with losartan and hydrochlorothiazide (HCT).Material and methods. To open observational study, lasting 12 weeks, 25 patients included, those who had been taking losartan+HCT 100/12,5 mg. Results. During the study, all patients underwent 24 hour BP monitoring, applanation tonometry (augmentation index assessment and of central BP), measurement of pulse wave velocity (PWV), laboratory tests (lipids, fasting glucose, HOMA index, homocystein, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP), vascular age assessment). After shifting the therapy with losartan and HCT to combination perindopril and indapamide, BP decreased additionally by 3,9%, and diastolic BP — 5,4% (p&lt;0,05). There was decrease of augmentation index by 9,4% and vascular age by 6,0% (p&lt;0,05). There was also decrease of leptin level by 14,5%, hsCRP by 11,0%, and increase of adiponectin by 9,9% (p&lt;0,05).Conclusion. The fixed combination perindopril and indapamide does have advantages for losartan and HCT combination in BP control, vascular elasticity improvement, and facilitates the decrease of body mass index, insulin resistance and non-infectious inflammation.

Efficacy and Tolerability of Fixed-Dose Combination Perindopril/Indapamide in Hypertensive Patients with a History of Stroke or Transient Ischemic Attack: PICASSO Trial

In everyday medical practice, physicians often need to manage patients whose blood pressure is not well controlled. Those with a history of cerebrovascular disease are a high-risk group in need of rapid blood pressure control. The PICASSO study was a real-life, observational trial involving 9257 inadequately treated hypertensive patients who were switched from previous therapy to the fixed-dose combination of perindopril 10mg/indapamide 2.5mg (PI) for 3months. A subanalysis of data of 1117 hypertensive patients who met the clinical criteria of previous stroke or transient ischemic attack was performed. Twenty-four hour ambulatory blood pressure measurements (ABPMs) were also done in a small group of patients (n:38). At baseline, mean systolic/diastolic blood pressure (SBP/DBP) was 161.5 ± 15.2/93.1 ± 9.9mmHg. After 1month with the fixed dose of PI, average office SBP/DBP decreased to 140.0 ± 11.9/83.5 ± 7.7mmHg. After 3months, SBP/DBP had dropped to 132.9 ± 9.8/80.0 ± 6.2mmHg, by 28.6 ± 15.5/13.1 ± 10.0mmHg (p < 0.001). Blood pressure control rate (< 140/90mmHg) was 67.3% after 3months. When data were stratified by baseline blood pressure, decreases in SBP/DBP were statistically significant in patients with all grades (1-3) of hypertension. In patients previously treated with an angiotensin-converting enzyme inhibitor ± hydrochlorothiazide (n = 677), blood pressure decreased by 29.8 ± 15.5/13.3 ± 10.2mmHg (p < 0.001). Decreases in 24-h ABPM values were also significant (n = 38). Treatment was well tolerated; only a few adverse events were recorded. This study suggests that fixed combination perindopril 10mg/indapamide 2.5mg is an effective and well-tolerated treatment for patients with a history of stroke or transient ischemic attack. EGIS Pharmaceuticals Plc.

EFFICACY EVALUATION OF THE TRANSITION TO FIXED COMBINATION DRUG PRESTANCE IN PATIENTS WITH INSUFFICIENT CONTROL OF BLOOD PRESSURE BY OTHER ANTIHYPERTENSIVE MEDICATIONS OR COMBINATIONS: REGIONAL PROGRAM OBJECTIVE

Aim.To evaluate efficacy of the fixed combination of perindopril arginine and amlodipine (original drug PRESTANCE, JSC “Servier”, France) in achievement of blood pressure (BP) control in patients non­controlled with other antihypertensive medications.Material and methods. In the study, in real world setting, 250 arterial hypertension (AH) outpatients were included. The levels of systolic (SBP) and diastolic (DBP) blood pressure were assessed and “vascular age”, at baseline, in 1 and 3 months (visit 2) of treatment with PRESTANCE.Results. In transition of patients to PRESTANCE there was decrease of SBP from 166,6±8,9 to 142,1±6,1 mmHg in 1 month (р&lt;0,001) and to 131,1±6,1 mmHg in 3 months. (р&lt;0,001), that is by 36 mmHg. BP decrease with the studied drug was similar in men and women, in patients older and younger 60. Target BP was reached in 79,6% of patients. The parameter “vascular age” after transition to PRESTANCE decreased in 3 months from 67,3±10,5 y. o. to 59,2±8,86 y. o., that is by 8,1 years.Conclusion.Transition from mono­ or combination therapy to fixed combination of perindopril arginine/amlodipine releases rapid and potent antihypertensive efficacy in patients not reached the target BP at any previous therapy, including combination of perindopril with amlodipine.

Terapia złożona w nadciśnieniu tętniczym — połączenie perindoprilu, amlodipiny i indapamidu

Hypertension is one of the epidemiologically most important causes of death in the world. At the same time, its incidence is constantly increasing. Effective control of blood pressure plays a key role in reducing cardiovascular risk and overall mortality. Unfortunately, the majority of Polish patients do not reach the target blood pressure. Improvements in this area can be obtained by using fixed-dose combination drugs. This article, on the basis of the presented clinical case, discusses the benefits of combined antihypertensive therapy, in particular the fixed-dose combination of perindopril with amlodipine and indapamide.

Treatment with triple combination of atorvastatin, perindopril, and amlodipine in patients with stable coronary artery disease: A subgroup analysis from the PAPA-CAD study.

BackgroundIn patients with stable coronary artery disease, aspirin, a statin, and an angiotensin-converting enzyme inhibitor are recommended as first-line agents for secondary prevention. Subgroup analyses of the previously published Hungarian Perindopril plus Amlodipine in PAtients with Coronary Artery Disease (PAPA-CAD) non-interventional trial demonstrated that the addition of the metabolically beneficial, fixed combination of perindopril + amlodipine to atorvastatin further improves the patient’s lipid profile.MethodsThe PAPA-CAD study, a 6-month open-label, prospective, multicenter, observational/non-interventional survey evaluated data accumulated from patients with hypertensive patients with stable coronary artery disease. The herein-reported subgroup analysis was conducted using the findings from those 1130 patients, who were taking atorvastatin in addition to the fixed combination of perindopril + amlodipine at the time of all four study visits (i.e., at baseline and 1, 3, and 6 months later).ResultsIn the subgroup of patients taking atorvastatin as an add-on agent, 82.5% reached the target blood pressure of 140/90 mmHg compared with 78.8% of those not taking a statin. The addition of atorvastatin to the fixed combination of perindopril + amlodipine resulted in further significant improvements of key metabolic parameters.ConclusionThis subgroup analysis confirmed that favorable synergism exists among perindopril, amlodipine, and atorvastatin.

Organoprotective properties of therapy by fixed combination of perindoprile and amlodipine in patients with arterial hypertension and diabetes mellitus type 2

Actuality: the contribution of changes in central aortic pressure (CAP) to target organ damage and the effect of a fixed combination of perindopril with arnolate with amlodipine besylate on these parameters in patients with arterial hypertension (AH) and type 2 diabetes (DM) has not been studied. Objective: to reveal the relationship between the main indicators of CAP and the damage of target organs (vessels, kidneys and heart) in patients with AH and type 2 diabetes; assess the organoprotective properties of a 12-week therapy with a fixed combination of perindopril arginate with amlodipine besylate in this category of patients. Materials and methods: 30 patients with AH stage III and DM at the age of 45 to 65 years were examined. The indicators of CAP were determined by Vasotens 24 software (“Petr Telegin” LLC, Russia). The structural and functional state of the myocardium was assessed echocardiographically with a Doppler sensor. The pulse wave velocity (PWV) was measured with Polyspectr 8/E apparatus (Neurosoft, Russia). To evaluate the kidney function, the glomerular filtration rate (GFR) was calculated, and albumin excretion in the urine was determined. A fixed combination of perindopril arginine / amlodipine besylate was administered for 12 weeks. Results: 12-week therapy was accompanied by the achievement of target values of blood pressure in 100% of patients, a decrease in office systolic and diastolic blood pressure. There was a significant improvement in indicators of CAP, which was accompanied by a statistically significant decrease in PWV in vessels of the elastic and muscular type, an improvement in the functional state of the kidneys: a decrease in the level of the albumin/creatinine ratio of urine, an increase in rGFR, by a significant decrease in the left ventricular myocardium index. Conclusion: admission of a fixed combination of perindopril and amlodipine in patients with AH in combination with type 2 diabetes for 12 weeks is accompanied by reliable cardio, nephroprotective and endotheliotropic effects, statistically significantly reduces systolic and diastolic CAP, augmentation index in daytime and night hours, leads to a significant reduction of rigidity of the main arteries.

Effectiveness of a Fixed-Dose, Single-Pill Combination of Perindopril and Amlodipine in Patients with Hypertension: A Non-Interventional Study.

IntroductionWe conducted a prospective, non-interventional, multicenter study to examine the effect of a fixed-dose combination of perindopril/amlodipine in patients with arterial hypertension.MethodsPatients who were previously untreated or required a change in medication were treated with a fixed combination of perindopril/amlodipine (3.5/2.5 or 7.0/5.0 mg) for 12 weeks. Changes in office, home and ambulatory blood pressure (BP) were recorded. Adherence was assessed by the Hill-Bone medication adherence scale.ResultsOverall, 1814 patients (mean age 60.0 ± 13.4 years) were included in 614 German practices, and data of 1770 patients were analyzed. At study entry, 97.7% of patients received perindopril/amlodipine at a daily dose of 3.5 mg/2.5 mg, and 47.9% of patients remained on this dose during the study period. Treatment with perindopril/amlodipine decreased mean office BP from 163.7/95.4 to 133.6/80.3 mmHg (p < 0.0001), resulting in a hypertension control rate of 69.1%. Blood pressure control was comparable in previously untreated and treated patients (70.3 vs. 68.1%), and in younger and older patients (70.6 < 65 vs. 66.3% ≥ 65 years). Ambulatory BP measurements were available in a subgroup of patients (n = 167), and mean 24 h ambulatory BP decreased from 150.6 ± 12.6/88.9 ± 8.8 to 132.4 ± 11.9/79.4 ± 8.5 mmHg (p < 0.0001). Furthermore, the proportion of patients with severe hypertension European Society of Hypertension/European Society of Cardiology (ESH/ESC) grade II or III decreased from 64.4 to 3.9%, and patients with pre-existing isolated systolic hypertension (n = 284) converted to normal BP in 67.6% of cases. Nearly half of the patients (47.2%) were perfectly adherent during the study. In previously treated patients, the percentage of patients with perfect adherence increased from 20.6% prior to study to 43.5% at final visit (p < 0.0001). Adverse drug reactions were documented for 4.9% of patients.ConclusionA fixed-dose combination of perindopril/amlodipine shows significant blood pressure reduction and improvement in medication adherence in a primary care setting.Trial RegistrationISRCTN26323538.FundingServier Deutschland GmbH.

Место фиксированной комбинации периндоприла и бисопролола в лечении сердечно-сосудистых заболеваний

Место фиксированной комбинации периндоприла и бисопролола в лечении сердечно-сосудистых заболеваний

THE CONTENTS OF SCD40 AND INDICATORS OF DAMAGED ENDOTHELIUM IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Introduction. Impairments of endothelial structure and functions of renal vessels are regarded as important factors of progression and chronization of chronic kidney disease (CKD). It is well known that the CD40/CD40L interaction is responsible for the aggregation of blood cells and their adhesion to the vascular wall, as well as its effect on the state of immune response. We investigated whether this interaction could be altered in patients with CKD and impaired immune status.&#x0D; Materials and methods. We examined 48 patients with chronic glomerulonephritis (CGN), 38 patients with chronic pyelonephritis and 42 patients with essential hypertension (EH) - control group. All patients received standard therapy with an ACE inhibitor perindopril in combination with a calcium channel&#x0D; antagonist amlodipine. Along with standard therapy the patients intravenously administered injections of "Kardioarginine." The degree of endothelial damage was assessed by the number of CEC and VE-cadherin content in blood plasma. In order to estimate changes in the immune status we determined the content of sCD40 in serum.&#x0D; Results. Increase in the content of serum sCD40 was shown for the CGN patients compared with healthy subjects and EH patients. The level of sCD40 in serum correlated with the number of CEC and VE-cadherin content in plasma. The use of kardioarginine combined with standard therapy led to reduction of sCD40 and stabilized the structure of endothelium. The loss of endothelial integrity in patients with CKD is apparently due to the activation of apoptosis with subsequent accelerated desquamation under the influence of activated white blood cells and the system of cytokines.&#x0D; Conclusions. The increase of sCD40 in patients with CKD may be a compensatory mechanism aimed to reduce the inflammatory activity by blocking the CD40/CD40L interaction at the cellular level.

EFFECT OF COMBINING LOSARTAN AND PERINDOPRIL IN DIABETIC PATIENTS WITH PROTEINURIA

Objective: This retrospective study compared the efficacy and safety of losartan monotherapy versus losartan and perindopril combination therapy in diabetic patients with hypertension and albuminuria. Factors affecting the change in albuminuria were identified.Methods: Through quota sampling, the study recruited patients from a tertiary care hospital. Outcome parameters included urinary albumin creatinine ratio (UACR), blood pressure (BP), serum creatinine, and estimated glomerular filtration rate (eGFR). Both pre- and post-treatment measurements were traced from patient’s medical records.Results: No significant differences (p=0.615) were detected in the pre- and post-treatment change in UACR between the monotherapy group (−38.3 mg/g, interquartile range [IQR]:−618.8-0) and combination therapy group (−88.4 mg/g, IQR: −729.3-+375.7). There was a considerably higher percentage of patients attaining the target BP of &lt;125/75 mmHg in the combination group (66.7%; p&lt;0.001). In terms of safety, combined losartan and perindopril caused more hypotension (p=0.003), higher rise in serum creatinine (p=0.481), and greater drop in eGFR (p=0.861). Body mass index was shown to have significant negative correlation with UACR reduction (r=−0.449; p=0.036).Conclusion: The main finding of this study was that losartan alone was as equally efficacious as combined losartan and perindopril in lowering UACR and BP among diabetic patients.

Efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders

To evaluate the efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders (DD). 153 patients with uncontrolled hypertension were examined, of whom 82 patients were diagnosed with mild and moderate DD. A combination of perindopril 10 mg/day, indapamide SR 1.5 mg/day, and amlodipine at an initial dose of 5 mg/day was given to patients with hypertension and DD. After 4 weeks of treatment, if target blood pressure (BP) levels could not be achieved, the dose of amlodipine was increased up to 10 mg/day. General clinical examination and 24-hour BP monitoring (BPM) were performed in all the patients at baseline and in the patients with DD also after 24 weeks of therapy. The traditional measures of the diurnal BP profile, as well as the parameters characterizing arterial stiffness and central aortic pressure (CAP) were estimated. After 8 weeks of therapy, target BP levels were recorded in 63 (76.8%) patients. After 24 weeks of treatment, the hypertensive patients with DD showed significant positive changes in all the investigated 24-hour BPM parameters and normalization of the diurnal BP profile in 65.1% of cases. During the treatment, there were significant decreases in pulse wave velocity, brachial arterial and aortic augmentation indices, aortic systolic and diastolic pressures, and mean aortic BP and an increase in the velocity of the reflected wave. Triple therapy, including perindopril, indapamide SR, and amlodipine, contributed to the achievement of target BP levels in the majority of hypertensive patients with DD, with significant positive changes in all 24-hour BPM parameters, optimization of the diurnal BP profile in most patients, clinically significant improvement of the parameters that characterize arterial stiffness and CAP.

Effect of a fixed-dose combination of perindopril arginine/amlodipine on the level and variability of blood pressure according to its office visit-to-visit measurements and self-measurements at home: A subanalysis of the PREVOSHODSTVO (SUPERIORITY) program

To study the effect of a fixed-dose combination of perindopril arginine/amlodipine (prestans) on the goal levels and variability of blood pressure (BP) according to its office visit-to-visit measurements and self-measurement (OVVM and SM) in a subgroup of 483 people from the population of the Russian observational SUPERIORITY program, most cases of whom are given the combination replacing the previously ineffective mono- and combination antihypertensive therapy (AHT). The subanalysis included data on 483 patients (34% men) aged 57.9±10.8 years with uncontrolled hypertension, who were both untreated and treated with antihypertensive mono- or combination therapy using a free or fixed-dose combination of 2-3 antihypertensive drugs and in whom the physicians decided to use prestans to correct AHT. The follow-up period was 24 weeks. At the end of the investigation, the patients received prestans in the following doses: 5/5 mg (34% of the patients), 10/5 mg (39.5%), 5/10 mg (3.9%), and 10/10 mg (22%). In the analyzed patient group, the baseline BP was 160.8±8.8/92.6±7.4 mm Hg and dropped to 125.9±7.9/77.8±5.0 mm Hg at 24 weeks (p<0.001). According to SM, the morning BP significantly decreased from 147.0±13.3/85.6±7.2 to 127.5±8.3/78,9±5.6 mm Hg at 24 weeks (p<0.001). The evening BP readings showed the similar trends. Target BP was achieved in 93 and 78% of the patients, as shown by OVVM and SM, respectively. According to SCM, the day-to-day variability of BP significantly decreased from 5.1±3.2/3.4±2.3 Hg mm at Visit 2 to 2.7±2/0/2,3±1/5 mm Hg at Visit 5 (p<0.001). The use of the fixed-dose combination of perindopril arginine/amlodipine in hypertensive patients just at the beginning of treatment, by switching from insufficiently effective mono- or combination AHT to the fixed-dose combination of perindopril arginine/amlodipine, is an effective way to optimize AHT in clinical practice, which lowers the BP level and variability, as evidenced by both OVVM and SM.

Fixed combinations of perindopril and indapamide in hypertensive high-risk patients: antihypertensive efficacy

Objective.The aim of the study was to compare the antihypertensive efficacy of fixed combinations of perindopril and indapamide in patients with arterial hypertension (HTN) and high cardiovascular risk.Design and methods.We included 65 patients with 1–2 degree of HTN who had not taken the studied drugs before: either perindopril arginine / indapamide 10 mg + 2,5 mg, n = 35), or indapamide / perindopril erbumine K 2,5 mg + 8 mg, n = 30). Clinical efficacy of antihypertensive therapy was evaluated at three different time points. We assessed objective clinical status, blood biochemistry, office blood pressure (BP), and parameters of daily monitoring of BP (MBP).Results.Perindopril arginine plus indapamide vs indapamide plus perindopril erbumine K after 4 and after 12 weeks shows higher antihypertensive effect regarding office BP and provides significantly better control of the daily BP profile based on the MBP results. Therefore, MBP is required in HTN high-risk patients who take indapamide / perindopril erbuminе K in order to assess the reduction in nighttime BP, independently of achieving target office BP values.

Czy terapia nadciśnienia tętniczego może zmniejszyć ryzyko zaburzeń funkcji poznawczych i otępienia?

Hypertension is an important risk factor for cardiovascular diseases and dementia. The efficacy of antihypertensive therapy, however, is still insufficient. Combination therapy of hypertension at least two drugs achieves the target blood pressure. The combination of perindopril and amlodipine is extensively studied well the combination of drugs, for which demonstrated a reduction in total mortality and cardiovascular events and stroke. The review explores molecular and clinical studies that might help explain the relation between the renin-angiotensin system, hypertension, and dementia and whether treatment with ACE inhibitor (perindopril) and CCB (amlodipine) have a part to play in the management of the disease.

The Antihypertensive Efficacy of the Triple Fixed Combination of Perindopril, Indapamide, and Amlodipine: The Results of the PETRA Study.

The etiology of essential hypertension is multifactorial. Therefore, treatment with combinations of antihypertensive agents acting on multiple targets is necessary for successful therapy in the majority of patients. According to the experience and clinical data accumulated so far, combination therapy with three agents from different pharmacological classes is required in approx. 30% of patients in order to achieve long-term blood pressure control. The primary objective of the PETRA study was to evaluate the efficacy of blood pressure (BP) control with once daily administration of the different dosage strengths of the once-daily, triple fixed combination of perindopril, indapamide, and amlodipine. The evaluation was based on office BP readings and ambulatory blood pressure monitoring (ABPM) data gathered in routine clinical practice. Data from 11,209 hypertensive patients (the proportion of female subjects was 47.6%) were processed and interpreted in a 3-month-long prospective, observational, non-interventional, open-label study conducted in 997 centers in Hungary. Mean baseline office BP was 156.58±16.10/91.56±9.33mmHg (mean±SD), whereas the mean duration of hypertension was 9.48±7.19years. Mean office BP decreased by 24.81±15.47/11.41±9.90mmHg after switching to the triple fixed combination of perindopril, indapamide, and amlodipine (p<0.0001). At the final visit 45.1% of patients took the 5/1.25/5mg, 33.5% of them 10/2.5/5mg, and 21.4% of them 10/2.5/10mg strength of the perindopril/indapamide/amlodipine triple fixed combination. The 24-h blood pressure was obtained in 76 subjects. The mean 24-h BP decreased from 155.51±17.43/85.28±11.48 to 134.63±12.51/77.83±8.99mmHg (p<0.0001). Statistically significant (p<0.0001) and clinically relevant improvement of a number of metabolic parameters-including total cholesterol (-8.6%), LDL-cholesterol (-11.4%), triglyceride (-12.1%), and fasting blood glucose (-6.6%) levels-was observed over the 3-month study period. During the 3months of the PETRA study, the outstanding 24-h antihypertensive efficacy of the triple fixed combination of perindopril, indapamide, and amlodipine was confirmed both by office BP readings and by ABPM recordings. This combination may offer a new therapeutic option for hypertensive patients who have failed to achieve the desired BP target on their previous dual combination therapy. EGIS Pharmaceuticals PLC.

A new fixed combination of perindopril, indapamide and amlodipine. "Three in one" is the way to improve the results of arterial hypertension treatment

The management of patients with arterial hypertension is a difficult problem even if use the modern antihypertensive drugs. The reasons of the inadequate control to arterial pressure level during the treatment are different. The application fixed combinations of antihypertensive drugs improves the results of therapy, weigh with separate pathogenetic mechanisms of blood pressure increasing and the counterregulatory effects of the treatment each components of the combination. The use of fixed combinations significantly increases patient adherence to treatment. A new fixed triple combination of perindopril, indapamide, amlodipine expands therapeutic options for the treatment arterial hypertension. The effectiveness of the use of each of the components and their combination is proved in large international studies.

Single-Pill Combination of Perindopril/Indapamide/Amlodipine in Patients with Uncontrolled Hypertension: A Randomized Controlled Trial.

IntroductionPatients with hypertension often require a combination of three antihypertensive agents to achieve blood pressure control, but very few single-pill triple combinations are available. The aim of this study was to determine whether a single-pill triple combination of perindopril, indapamide, and amlodipine was as effective as a dual-pill combination of perindopril/indapamide plus separate amlodipine at reducing blood pressure in patients with uncontrolled, essential hypertension.MethodsThis international, multicenter, open-label, randomized controlled trial was conducted in men or women aged ≥18 years old with confirmed essential hypertension (SBP ≥140 and <160 mmHg and DBP ≥90 and <100 mmHg), uncontrolled on maximal dose antihypertensive monotherapy or with a single dose of dual therapy. Patients were randomly assigned to: single-pill triple combination of perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg (Per/Ind/Aml) or dual-pill combination perindopril 5 mg/indapamide 1.25 mg + amlodipine 5 mg (Per/Ind + Aml) once daily for 12 weeks. The primary endpoint was change in office supine SBP and DBP from baseline to week 12. The proportion of responders defined as those with normalized BP (SBP <140 mmHg and DBP <90 mmHg), and/or decrease of SBP ≥20 mmHg, and/or decrease of DBP ≥10 mmHg at week 12 (W12) compared with baseline was also assessed. Secondary efficacy endpoints included change in office supine SBP and DBP, response, and BP control at weeks 4 and 8. The tolerability of the treatments was also assessed.ResultsA total of 148 patients were randomized: 75 to Per/Ind/Aml and 73 to Per/Ind + Aml. Mean supine SBP and DBP were 149.1 ± 4.7 and 94.1 ± 3.1 mmHg, respectively, with no relevant between-group difference. At week 12, both triple-therapy regimens were associated with clinically significant reductions in SBP compared with baseline (−21.5 ± 11.7 and −20.0 ± 12.9 mmHg, respectively). Reductions in office supine DBP were also clinically significant (−15.3 ± 7.8 and −14.8 ± 9.0 mmHg, respectively). The proportion of treatment responders was high in both groups: 89.2 and 87.1%, respectively. The reduction in office supine SBP/DBP was already evident at week 4 and maintained for the duration of the study in both groups. The majority of patients were treatment responders at week 4 (89.2 and 82.9%, respectively) and had achieved BP control (87.8 vs. 78.6%, respectively), which was maintained until week 12 in both treatment groups. Both treatments were well tolerated with no between-group differences.ConclusionsIn adult patients with uncontrolled essential hypertension on treatment, single-pill triple-combination therapy with Per/Ind/Aml is as effective as the same dose dual-pill combination of Per/Ind + Aml. Both treatments were associated with clinically significant BP reductions compared with baseline and were well tolerated. Clinical trials number: http://www.controlled-trials.com ISRCTN: 16442558. Funding: Les Laboratoires Servier.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-017-0085-7) contains supplementary material, which is available to authorized users.

Prognostic Value of Melatonin Level, Structural and Functional Changes of the Myocardium in the Development of Complications in Patients With Heart Failure who Underwent Coronary Artery Bypass Grafting: the Possibilities of Pharmacological Cardioprotection

To assess the significance of melatonin, NT-proBNP and morphological markers of myocardial remodeling for predicting the risk of complications after coronary artery bypass grafting (CABG) in patients with ischemic heart disease and chronic heart failure (CHF). We included in this study 83 patients who underwent CABG in the period from September 2013 to October 2014. All patients before CABG underwent standard laboratory and instrumental examination. Concentrations of melatonin and NT-proBNP were measured in 2 days before and after surgery. The evaluation of morphological markers of myocardial remodeling (expression of MT2 melatonin receptors [MTR2], caspase-3, bcl-2) was carried out in tissue samples taken at biopsies of the right atrial appendage during CABG. Analysis of groups of patients with favorable and unfavorable hospital outcomes revealed no significant differences in serum levels of NT-proBNP. There was a significant decrease in the level of melatonin in the subgroup of patients with unfavorable outcome of CABG in combination with high comorbid load and high degree of apoptosis of cardiomyocytes at the background of moderate and high MTR2 expression. Comparative assessment of pharmacotherapy prior to CABG revealed favorable effect on myocardial remodeling of a combination of perindopril and amlodipine. Preoperative evaluation of the level of melatonin sulfate, apoptosis markers, and comorbid load can serve as prognostic factors of complicated course of the postoperative period after CABG in patients with CHF. The combination of perindopril and amlodipine in patients with heart failure with preserved ejection fraction exerted a significant cardioprotective effect on the myocardium, contributing to a decrease of the apoptotic dominant.