Combination Of Perindopril Research Articles

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.

ROLE OF GENDER SPECIFICS IN MYOCARDIAL REMODELLING, CARDIOVASCULAR COMPLICATIONS DEVELOPMENT AND EFFICACY OF PHARMACOTHERAPY IN HEART FAILURE PATIENTS AFTER CARDIAC SURGERY

Aim. To assess gender influence on myocardial remodelling, pharmacotherapy efficacy and complications development in chronic heart failure patients (CHF) post cardiac surgery. Material and methods. In the study, 87 patients included, both genders, with CHF, who had been planned for cardiac surgery. All underwent standard investigations and CHF treatment, as other pathologies. Myocardium specimens from the right atrium appendage (RAA) were collected during surgery, investigated with general histology, immune histochemistry (expression of MMP-9, TIMP-1 and р38αMAPK) methods. For the evaluation of treatment influence on myocardium, intervention groups were selected: enalapril and metoprolol, perindopril and amlodipine (Prestance®, “Les Laboratoires Servier”, France). In all participants, at 10-14 day post surgery, the rate of complications was evaluated, by groups. At least one complication led to selection the participant as adverse in-hospital outcome. The relations were studied, of post-surgery complications with EchoCG data and morphological changes in LAA myocardium, taken the gender and left ventricle ejection fraction (LVEF). Results. In cardiac surgery group with heart failure and preserved LVEF (HFpEF) with the increase of CHF functional class, normal LVEF remained, and there was worsening of the LV diastolic function. In HFpEF males there was decrease of EF with transition to “grey zone” by III functional class, and eccentric remodeling predominated with unchanged diastolic function. In HF mid-range EF group, regardless of gender, there was eccentric LV remodelling. In RAA myocardium of women there was lower grade of myocardial fibrosis and mononuclear areas of infiltration, and there was higher rate of cardiovascular as extracardiac complications. High grade of MMP-9 in RAA revealed in the group of HF mid-range EF and adverse outcome, regardless gender, and increased expression of р38αMAPK in females of thisgroup. In perindopril and amlodipine group there was lower grade of MMP-9 and р38αMAPK expression. Conclusion . The study demonstrated gender differences in remodelling of myocardium in HFpEF patients. This makes to consider female gender, HF midrange EF, MMP-9 expression in RAA myocardium, as prognostic markers of surgery adverse outcome. Combination of perindopril and amlodipine demonstrated protective influence on myocardium, with more prominent effect in females.

INFLUENCE OF THE COMBINATION DRUG PRESTANS (PERINDOPRIL A, AMLODIPINE) ON MORPHO-FUNCTIONAL PARAMETERS OF ARTERIAL BED IN ESSENTIAL HYPERTENSION

Aim. Recently, the problem of endothelial dysfunction is in high interest. It was proved that microcirculatory disorders play main role in development and progression of target organ damage in essential arterial hypertension (EAH). Microcirculatory bed itself should be the target of EAH. Modern antihypertension drugs, despite of normalization of blood pressure (BP), should fulfill the prevention of target organ damage. In our study, the influence was evaluated, of treatment with the fixed combination of perindopril A and amlodipine (Prestans®, “Les Laboratoires Servier”, France) on structural and functional parameters of the heart and vessels. Material and methods . In the study, 30 patients with grade II-III EAH included, mean age 54,12±9,15 y.o., duration of EAH — 12,6 (4;21) years. For the assessment of endothelial function and structural and functional condition of capillary net of a finger skin, photopletysmography were applied and videocapillroscopy, respectively. Results . Therapy with Prestans® led to improvement of functioning of the middle sized vessels and microcirculatory vessels (MC) (increase of occlusion index on MC level from 1,5 to 1,8, p<0,006); on the large vessels level led to phase shift from 6,0 to 10,3 (р<0,00005). There was influence of Prestans® on the parameters characterizing vascular bed remodelling on the levels of cappilars: density of capillary net in the skin at rest (cap/mm 2 ) increased from 47 cap/mm 2 to 51 cap/mm 2 (р<0,00005), and the density of capillar net after venous occlusion test — from 53 cap/mm 2 to 60 cap/mm 2 (р<0,006). Conclusion. Prestans® is a medication of choice not only for AH treatment, but for prevention of target organs damage, that is based on correction of endothelial dysfunction and morphofunctional parameters at the level of MC.

Новая фиксированная комбинация периндоприла, индапамида и амлодипина. «Три в одном» – путь к улучшению результатов терапии артериальной гипертонии

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.

USING A COMBINATION OF PERINDOPRIL, INDAPAMIDE AND ROSUVASTATIN IN THE TREATMENT OF PATIENTS WITH HYPERTENSION AND DYSLIPIDEMIA

Aim . To study the antihypertensive and hypolipidemic effect of a group of drugs including perindopril,rosuvastatin and fixed-dose combination of perindopril and indapamide, in ambulatory patients with hypertension and dyslipidemia. Material and methods . Analysis of the medical data of patients treated with perindopril, indapamide and rosuvastatin in the multicenter, non-interventional study (SYNERGY) was performed. Patients had a diagnosis of hypertension and dyslipidemia, determined in routine clinical practice. Therapy was prescribed to patients in various dosing regimens. The data of anamnesis, physical status, blood pressure measurements, lipid levels were taken from the patient's medical records. The safety assessment was also performed. The duration of follow-up was 8 weeks. Results . A total of 1383 patients were included into the analysis, 53.5% (n=740) of women and 46.5% (n=643) of men. The average age was 55.8 years. 914 patients (66.1%) had previously received antihypertensive therapy, and 439 (31.7%) had previously received lipid-lowering therapy. A significant reduction in the levels of systolic (SBP), diastolic BP (DBP), and low-density lipoprotein cholesterol (LDL-c) was found at the end of the study in all study groups (p<0.05). This demonstrated an adequate antihypertensive and lipid-lowering effect of all treatment regimens. The mean decrease in SBP in treatment groups ranged from 14.3 to 36.2 mm Hg; the mean decrease in DBP – from 3.3 to 22.2 mm Hg. The maximum decrease in SBP was found in the group of perindopril + indapamide + rosuvastatin (PIR) 8 + 2.5 + 20 mg (36.2±12.3 mm Hg); the maximum decrease in DBP – in the group of perindopril + rosuvastatin 8 + 10 mg. The mean decrease in LDL-c level due to the combined treatment with perindopril, indapamide and rosuvastatin ranged from 0.62 mmol/L in PIR groups 2 + 0.625 + 5 mg and 8 + 2.5 + 5 mg to 1.78 mmol/L in PIR group 8 + 2.5 + 20 mg. Three of 1,383 patients reported adverse events after 4 weeks of treatment, while 13 patients – at the end of the study. Conclusion . PIR therapy resulted in a significant reduction in blood pressure in all treatment groups compared with baseline levels. A dose-dependent reduction in SBP and LDL-c levels was found in all treatment groups. The tolerability of all treatment regimens was good.

ADVANTAGES AND NOVELTY OF CLINICAL APPLICATION OF THE TRIPLE COMBINATION FOR ARTERIAL HYPERTENSION WITH DYSLIPIDEMIA: ACE INHIBITOR PERINDOPRIL WITH ROSUVASTATIN AND INDAPAMIDE

Aim. To assess efficacy and safety of double combinations (angiotensine converting enzyme inhibitor (ACEi) + indapamide) and triple combinations (ACEi + statin + indapamide) in arterial hypertnesion (AH) patients with dyslipidemia (DL). Material and methods. The study is based on the data analysis obtained during investigation and treatment of 75 patients at the age 40-65 y.o. with AH of I-II grades and high risk with DL (total cholesterol more 4,5 mM/L, and/or low density lipoproteides more than 2,5 mM/L). Results. During the study, additional properties of statins are shown, if added to standard bi-component hypotensive treatment by ACEi + indapamide, in patients with high cardiovascular risk (CVR). There is improvement of hypotensive and angioprotection effects. The advantages presented, as an additional angioprotection effect, endothelial function improvement and significance of clinical application of triple combination ACEi + rosuvastatin + indapamide in DL patients with AH of higher CVR. Conclusion . The data shows that combination of ACEi + statin + indapamide is able to most effectively decrease damage caused by inflammation on vascular endothelium. In the analogic by strength hypotensive action, within combinational therapy, there is summation of angioprotection effects of both drugs. Synergistic angioprotection action of combination therapy makes it to recommend triplecomponent combination of ACEi + statin + indapamide for broader implementation in AH of I-II grades patients and DL of higher CVR as a combination of the drugs of choice showing pathogenetic mechanisms of correction of arterial pressure, as metabolic disorders, and resulting in organoprotective effect of treatment. The main point of interest could be a fixed triple component combination of perindopril + rosuvastatin + indapamide.

The analisis of factors, associated with office and home blood pressure control in patients who received algorithmic antihypertensive therapy

Aim. To define factors, associated with attaining control of the office and home AP and with the number of necessary medicaments in patients with non-complicated AH after 6 month of algorithmic antihypertensive therapyMaterials and methods. 501 patients with AH received therapy according to the algorithm that provided successive prescription of fixed combination of perindopril, ampodipine and if necessary, indapamide-retard, spironolactone, moxonidine or doxazosin for attaining the target office AP. The office and home AP was assessed by certificated oscillometric devices. For determination of factors, independently associated with attaining the target level of office and recommended level of home AP after 6 months of therapy the multiple linear regressive analysis was usedResults. After 6 months the office SAP and DAP decreased from 165,7±13,9 to 131,0±9,5 and from 96,9±9,7 to 79,3±7,1mm of m.c., home – from 148,8±15,7 to 129,4±8,3 and from 87,8±10,0 to 77,9±7,2 mm of m.c. After 6 months the target office AP was attained by 80,1 %, recommended home – by 65,8 % of patients. After 7 days indapamide-retard was added to the therapy in 24 % of patients. At the end of research 165 (37,2 %) patients were treated by three or more preparations. The high inclination to treatment was detected in 49, moderate – in 43,6, low – in 7,4 % of patientsConclusions. The attainment of target office AP in patients with hypertension in 6 month of treatment was independently associated with female sex, age, initial level of office SAP, absence of the need in 3 preparations after 7 days of treatment, high compliance. The need of prescription of three and more preparations for AP control after 6 month was associated with low compliance, probable resistant AH before inclusion in the research, home SAP after 7 days and uncontrolled AH after 1 month of treatment

Evaluation of the pharmacoeconomic efficacy of prestance in the treatment of hypertensive patients on the basis of the results of the POTENTIAL program

To pharmacoeconomically estimate the use of a fixed-dose combination of perindopril and amlodipine in the treatment of hypertensive patients. A pharmacoeconomic study was conducted on the basis of the Russian postmarketing observational open program POTENTIAL, which included the estimation of direct and indirect costs associated with the addition of a fixed-dose combination of perindopril and amlodipine to conventional therapy for hypertension in patients who had not achieved adequate blood pressure (BP) control. Cost-difference, cost-effectiveness, and budget-impact analyses were carried out. The addition of prestance to conventional therapy for hypertension can reduce total costs by 5.-5.8 times, direct costs required to achieve 1% of patients with adequate BP control by 20.5-42.1 times, and direct costs to improve a patient's status by one visual analogue scale score by 1.03-2.11 times. Within a 5-year horizon, the administration of prestance can decrease the cost of therapy for high BP and related strokes by 1.39-1.46 times. Due its high efficacy, prestance (amlodipine + perindopril) is a pharmacoeconomically preferred alternative only to the conventional therapy for hypertension even if the least costly generics are used, in both the short and medium term.

Abstract 14002: Randomized Comparison of Once-daily Fixed Combination versus Free-drug Combination of Three Antihypertensive Agents

Background: A 3 drug combination strategy is often needed to achieve blood pressure (BP) targets. However, the optimal strategy of drug administration remains unknown. The aim of this study was to compare the efficacy and safety of once-daily fixed (ODF) combination versus free-drug combination of 3 antihypertensive agents. Methods: The ONE&amp;ONLY Trial was a randomized, prospective, multicenter trial. A total of 731 hypertensive patients (pts) treated with the combination of perindopril plus indapamide or amlodipine were screened initially. The 305 pts who did not meet the BP targets after 4 weeks were randomized to ODF combination of perindopril 10 mg + indapamide 2.5 mg + amlodipine 5 or 10 mg (N=154, fixed group) versus free-drug combination of the 3 antihypertensive agents (N=151, free group). Primary end-points were the differences in clinic BP between the 2 groups after 12 weeks. Secondary end-points included intragroup differences in clinic BP during the study period and achievement of BP targets at week 12. Safety and compliance were also assessed during the trial. Results: Baseline characteristics were similar among the treatment groups. At 12-weeks, the fixed group had lower systolic BP (SBP) (125±12 vs 129±11 mm Hg, p=0.002) and similar diastolic BP (DBP) (82±9 vs 84±7 mm Hg, p=0.082) compared to the free group. With respect to baseline measures, changes in BP with fixed combination were statistically significant for systolic (-18.9± 11.2 mm Hg, p&lt;0.01), and diastolic values (-6.3±5.7 mm Hg, p&lt;0.01). On free combination, changes vs. baseline in SBP and DBP, conversely, were of borderline significance. BP targets at week 12 were more commonly reached with fixed than free combination (89% [137 of 154] and 80% [121 of 151], respectively, p=0.048). Safety was not significantly different between the 2 groups. Conversely, compliance was significantly greater in the fixed-group vs the free-group (94% [144 of 154] and 85% [129 of 151], respectively, p=0.034). Conclusion: This randomized trial shows in a large population of hypertensive pts that ODF combination of perindopril, indapamide, and amlodipine is as effective and safe as free combination of the 3 drugs, although is associated with a significantly greater compliance. ClinicalTrials.gov ID: NCT02710539

Factors Associated with Masked Uncontrolled Arterial Hypertension in Patients Receiving Antihypertensive Treatment

The aim of the study: to determine the frequency of the identify using a home blood pressure measurement (BP) masked uncontrolled arterial hypertension (MUAH), its sustainability and its associated factors at different stages algorithmization antihypertensive therapy on the basis of a fixed combination of perindopril and amlodipine in patients with uncomplicated hypertension.&#x0D; Materials and methods. In an open prospective study were included 501 patients aged from 35 to 75 years (mean age 58,0±9.5 years). Of these, 221 cases (44.1%) patients with uncomplicated essential AH with AO ≥160/100 mm Hg (in individuals not previously treated) or ≥140/90 mm Hg in the case of the previously assigned antihypertensive therapy. The research design included a period of 6 months 6 visits: 7 days, 1, 2, 3 and 6 months. Step1by1step algorithm for the treatment of patients was provided for the appointment of a fixed combination of perindopril and amlodipine, consecutive appointment, if necessary, indapamide retard, spironolactone, moxonidine or doxazosin to achieve the target office BP.&#x0D; Results. It was found that the proposed algorithm treatment not only gives the opportunity for 6 months to achieve therapeutic goals relative to the target level of office BP in 78.9% of patients, but in 56,8% decrease among them the percentage of persons with the MUAH.&#x0D; Conclusion. According to the home definition of BP at different stages of antihypertensive therapy MUAH inherent to 23.5–51.6% of patients with controlled office AO and later persists not less than one-third of patients. Algorithmization antihypertensive therapy on the basis of a fixed combination of perindopril and amlodipine allows reducing the percentage of patients with MN of hypertension among patients with target office BP at 56.8 per cent for 6 months of treatment.

PS 14-41 SINGLE-PILL TRIPLE COMBINATION OF PERINDOPRIL/INDAPAMIDE/AMLODIPINE IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Hypertension is the major risk factor in Serbia for the morbidity and mortality of cardiovascular and cerebrovascular diseases. The majority of patients in Serbia need two or more antihypertensive drugs for adequate control of blood pressure. Design and Method: Study group consisted of 12 patients with uncontrolled essential hypertension without comorbidities randomized in two groups and followed for 12 weeks. The first group was treated with single-pill combination perindopril 5 mg/indapamide 1.25 mg and an additional tablet of amlodipine 5 mg. The second group received single-pill triple combination of perindopril 5 mg/indapamide 1.25 mg/amlodipine 5 mg. Results: Our research showed a significant decrease in systolic (132.5 vs. 140.5 mmHg, P = 0.05) and diastolic (84.50 vs. 83.83 mmHg, P < 0.05) blood pressure from baseline (153/84.50 mmHg vs. 149.17/94 mmHg) in both groups after 12 weeks of treatment. There was a higher proportion of patients achieving target blood pressure (<140/90 mmHg) in the single-pill triple combination group (69.7%) in comparison with the other group (50%). Conclusions: Our results showed significant reductions in blood pressure and a high BP control rate with the single-pill triple combination perindropil/amlodipine/indapamide in patients with uncontrolled essential hypertension without comorbidities.

PS 14-39 ROLE OF THE TRIPLE COMBINATION WITH INDAPAMIDE, NITRENDIPINE AND PERINDOPRIL IN RENAL PROTECTION

Objective: To study of antihypertensive and renoprotective efficacy of indapamide, nitrendipine and perindopril combination therapy in hypertensive patients with low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Design and Method: The study included 20 patients with II-III stage of essential hypertension (ESH/ESC 2013) and eGFR<60 ml/min/1.73 m2 in average age 60.17 ± 7.86 yrs. All patients were resistant to previously bi-component antihypertensive therapy. Blood pressure (BP) measured by Korotkov method. GFR estimated by MDRD formula. Levels of serum creatinine, uric acid and glucose were measured with biochemical assay method. All measurements performed before and after 24 weeks of triple combination, based on indapamide, perindopril and nitrendipine in average dose 2.15 ± 0.56 mg, 4.72 ± 1.79 mg and 12.77 ± 5.65 mg respectively. Results: During the 24 weekly antihypertensive therapy with three drug combination systolic BP decreased from 160.0 ± 15.81 to 127.3 ± 11.8 mmHg (p = 0.0001), and diastolic BP – from 98.94 ± 8.11 to 79.3 ± 6.24 mmHg (p = 0.0001). Serum creatinine level was significantly decrease from 110.59 ± 20.69 to 93.4 ± 19.67 μmol/L (p = 0.01). Plasma glucose and uric acid levels had tendency to decrease: from 5.77 ± 1.16 to 5.71 ± 1.56 mmol/L and from 6.36 ± 1.99 to 5.76 ± 1.78 mg/dL (p > 0.05) respectively. eGFR was improved during the 24 weekly treatment and increased from 51.04 ± 6.81 to 62.58 ± 13.12 ml/min/1.73 m2 (p = 0.003), eGFR elevated >60 ml/min/1.73 m2 in 50% cases. All patients finished 24-weekly therapy with good tolerability. Conclusions: 24-weekly therapy with indapamide, perindopril and nitrendipine were characterized with high antihypertensive efficacy and good tolerability. Three drugs combination also had shown renoprotective effects with significantly increase of eGFR in hypertensive patients.

Chronotherapy’s opportunities of a fixed combination of perindopril 10 mg/indapamide 2.5 mg in patients with a lack of night reduction in blood pressure

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP&gt;140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p

Risks associated with permanent discontinuation of blood pressure-lowering medications in patients with type 2 diabetes

The associations of discontinuation of the study medication on major outcomes were assessed in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Trial. ADVANCE was a factorial randomized controlled trial of blood pressure lowering (a fixed combination of perindopril and indapamide vs. placebo) and intensive glucose control (vs. standard glucose control) in patients with type 2 diabetes. Patients who permanently discontinued the randomized blood pressure-lowering medication during the study period (n = 1557) were compared with others (n = 9583). Cox's proportional hazards models were used to estimate the effects of the discontinuation on the risks of macrovascular events, microvascular events together and separately and all-cause mortality, using discontinuation as a time-dependent covariate. In multivariable analyses, discontinuation was associated with increased risks of combined macro and microvascular events (hazard ratio 2.24, 95% CI 1.96-2.57), macrovascular events (3.23, 2.75-3.79), microvascular events (1.38, 1.11-1.71), and all-cause mortality (7.99, 6.92-9.21) compared to continuing administration of randomized medications during the trial period, which were highest in the first year after discontinuation. These associations were similar in active and placebo groups, except in the first year after discontinuation during which event rates were lower in the active group than in the placebo group (P ≤ 0.01). Discontinuation of study medication is a potent risk marker for identifying high-risk patients. Thus it is important that clinicians seek to identify such patients early after discontinuation of treatment. Although some short-term residual effects of previous active treatment can be expected, patients who discontinue require further urgent investigation and management.

Kiedy i dlaczego w terapii hipotensyjnej wybieram połączenie trójlekowe — perindopril/indapamid/amlodipina?

Most of the patients with hypertension require combined therapy in order to achieve target blood pressure. Antihyper­tensive agents should improve compliance with medical recommendations and allow achieving therapeutic goals. The combination of perindopril with indapamide and amlodipine is particularly recommended in population of hypertensive patients with metabolic complications because of favourable, neutral effect on blood glucose and cholesterol level. This combination has proven hypotensive effect in group of patients with difficult-to-control hypertension.

Effectiveness of Dispersible Forms of Perindipril in Patients With Uncontrolled Arterial Hypertension in Clinical Practice

The study was aimed at evaluating the efficacy and usability of a dispersible form of perindopril in patients with arterial hypertension (HT) in clinical practice. The study enrolled 52 patients with newly diagnosed or uncontrolled HT of grade 1-2. The baseline assessment consisted of physical examination, instrumental and laboratory tests, including electrocardiography, clinical and biochemical blood tests, measurement of daily albuminuria, and estimation of glomerular filtration rate (GFR). The assessment was repeated at 12 weeks of treatment. The patients were asked to complete questionnaires at the first visit, in order to determine the potential need for administration of dispersible tablets, and at the last visit, to evaluate the convenience of their use. Depending on the baseline blood pressure (BP) and the risk for cardiovascular events, patients were treated with perindopril dispersible form 10 mg/daily in monotherapy, or with combination of perindopril 10 mg/daily in the dispersible form and indapamide retard 1.5 mg/daily. The interim assessments of the treatment efficacy and safety were carried out at 2 and 4 weeks, and the final assessment was performed at 12 weeks from inclusion. The target BP was achieved in 22 (42.3%) patients at 2 weeks, 35 (67.3%) patients at 4 weeks, and 50 (96.2%) patients at 12 weeks of treatment. The reductions in systolic and diastolic BP, assessed by office BP measurements and BP self-control, as well as reduction in heart rate became significant (<0.001) as earlier as after 2 weeks of treatment, and this trend continued up to 12 weeks. In addition, the treatment was associated with by a significant reduction in daily albuminuria, serum creatinine, and increase in GFR. According to the survey data, 71.4% of patients preferred dispersible form of perindopril to the ordinary one, considering it as more convenient, effective and applicable in various everyday situations. In patients with HT, the dispersible form of perindopril in monotherapy and in combination with a diuretic provides a rapid and substantial BP reduction, as well as the achievement of target BP values in the majority of cases. In addition, such a treatment is associated with a significant positive effect on the heart rate, as well as on the renal function. Treatment with a soluble form of perindopril is well tolerated by patients and is estimated by them as a convenient and effective one.

The gender characteristics of clinical somatic and psycho-emotional status in patients with chronic cardiac insufficiency

The article presents the results of evaluation of gender characteristics of clinical somatic and psycho-emotional status in patients with chronic heart failure and old myocardium infarction, including analysis of their relationship with psycho-emotional conditions and possibilities of pharmaceutical correction. All patients were subjected to common techniques of clinical examination including, besides medical history information gathering, physical examination, test with six minutes walking, evaluation of clinical conditions according NYHA scale (R. Cody, 1993 modification of V.Yu. Mareiev 2000). The sampling for examination included 150 patients survived myocardium infarction, 75 males and 75 females. All examined patients were randomized on three groups. The patients of first group (25 males and 25 females) were given basic therapy and Perindopril (Prestarium, Servier) as inhibitor of angiotensin converting enzyme in dosage of 5-10 mg per day. The patients of second group (25 males and 25 females) besides basic therapy were given Valsartanum (Diovan, Novartis) in dosage of 80-160 mg per day. The scheme of treatment of patients of third group (25 males and 25 females) besides basic therapy (with inhibitor of angiotensin converting enzyme and/or blocker of angiotensin receptors) included Sertralinum (Zoloft, Phizer) in dosage of 50 mg per day. In the group of examined patients with chronic heart failure and old myocardium infarction, males were younger than females. The psycho-emotional overloads as risk factor were observed more frequently in female patients. It is established that in group of patients with chronic heart failure and old myocardium infarction frequently occurs diabetes mellitus being that in 2.3 times more often in females than in males. The arterial hypertension was detected in all females with chronic heart failure and old myocardium infarction. The duration of arterial hypertension also has its characteristics: females suffered from arterial hypertension twice more often than males. The applied therapy provided comparative clinical effect both in males and females of all groups. Against the background of therapy the maximal effect was observed in group of patients received Perindopril in combination with Sertralinum. The following gender characteristics of risk factors in patients with chronic heart failure and old myocardium infarction were detected: in females arterial hypertension was occurred 1.4 times more often (100%) and diabetes mellitus was detected 2.3 times more often (30%) in comparison with males. The duration of arterial hypertension also had gender characteristics because females suffered from arterial hypertension 2 times more often than males. Taking into account increased level of anxiety in most of the patients with chronic heart failure and old myocardium infarction the application of Sertralinum in composition of combined therapy results in additional positive clinical effects that is expressed more reliably in females.

Gender differences of response to various options of drug therapy in patients with chronic heart failure after suffered myocardial infarction

Aim. To evaluate gender features of treatment in patients with chronic heart failure who suffered myocardial infarction, determine the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers II, as well as antidepressants in the clinico-functional and psycho-emotional status, morphological and functional parameters of the heart in the treatment of men and women with this pathology.Methods. The study included 205 men and 185 women with chronic heart failure after suffering a myocardial infarction. Patients were randomized into three groups. Patients of the first group (80 men and 70 women) received background treatment (cardiac glycosides, diuretics, aldosterone antagonists, prolonged nitrates if necessary, acetylsalicylic acid, atorvastatin and perindopril 5-10 mg/day. The patients of the second group (80 men and 70 women) received valsartan 80-160 mg/day in addition to the above-noted background treatment. In the therapeutic regimen of the third group of patients (45 men and 45 women) sertraline in a dose of 50 mg/day was included in addition to background treatment. All the patients underwent usual methods of general clinical examination, the 6-minute walk test, clinical status evaluation, the anxiety syndrome severity assessment using a Hamilton scale, echocardiography. The patients dynamic monitoring was carried out for 6 months.Results. The study results showed that provided therapy has comparable clinical effect in both men and women in all three groups. Statistically significant improvement in clinical condition indicators was reported and as a result, exercise tolerance increased. At the same time the quality of life improvement was more pronounced (p &lt;0.001) in patients of the third group, amid the perindopril and sertraline use. According to the results of our study in patients of all three groups provided therapy has a comparable positive effect on echocardiography indicators, including those which characterize left ventricular hypertrophy.Conclusion. Amid the provided treatment in all three groups positive dynamics of clinical status indicators and intracardiac dynamics was reported; in addition to that the dynamics of both clinical status and linear and volumetric heart parameters was more pronounced amid the treatment with perindopril in combination with sertraline.

The Efficacy of Perindopril/Amlodipine in Reaching Blood Pressure Targets: Results of the CONTROL Study.

Inadequate blood pressure (BP) control remains a serious concern worldwide. Recent evidence suggests that the combination of a calcium channel blocker (CCB) with an angiotensin-converting enzyme inhibitor (ACEi) in patients with essential hypertension provides effective BP control with decreased adverse cardiac and renal events. This study was designed to quantitatively evaluate the efficacy and tolerability of a fixed dose combination of perindopril and amlodipine in the Kingdom of Saudi Arabia on a population of patients with essential hypertension, as well as to identify the predictors of BP control in this population. This was an observational, multicenter, open-label cohort study of patients with essential hypertension with or without diabetes mellitus, treated with a fixed dose combination of perindopril and amlodipine. Patients were followed up in four-week intervals for a total of 12 weeks. They were initially started on the lowest dose of the ACEi/CCB combination and up-titrated at each follow-up according to their response to treatment. The primary end-point of the study was the percentage of patients with controlled BP at study termination (week 12). A total of 1996 patients completed the study. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) control was observed in 93.3% of patients at week 12. As for the predictors of BP control, it was found that female gender was associated with more BP control [odds ratio (OR) = 1.76, 95% CI: 1.14-2.70, p value = 0.01], whereas older age was associated with less BP control (OR = 0.98, 95% CI: 0.96-1.00, p value = 0.02). Similarly, having type I and type II diabetes mellitus was also associated with less BP control (OR = 0.19, 95% CI: 0.08-0.45, p < 0.0001 and OR = 0.33, 95% CI: 0.22-0.48, p < 0.0001, respectively). In a qualitative assessment, both investigators and patients perceived efficacy and tolerability of perindopril/amlodipine to be excellent. We found that a fixed combination of perindopril/amlodipine is effective in controlling BP in patients with essential hypertension, with older age, male gender, and diabetes mellitus being independent risk factors for less BP control.

Как увеличить эффективность антигипертензивной терапии в реальной клинической практике: результаты российской наблюдательной программы ФОРСАЖ

im of the study - to evaluate the possibility of increasing the effectiveness of antihypertensive therapy by simplifying regimens, improving knowledge and practical skills of the doctors on the use of modern tactical approaches to treatment as well as patients education methods of measuring blood pressure (BP), the principles of a healthy lifestyle and explain the need to follow the prescribing physician.Post-marketing observational discovery program FORSAZH held in 29 cities of the Russian Federation. Participation in the program received 442 physician (internists and general practitioners), which included 1969 patients with prior failure of combination antihypertensive therapy. Patients in 86% of cases took the free combination, 14% - fixed combinations of drugs. The change of the treatment on reception of a preparation containing a fixed combination of perindopril/indapamide (10 mg/2.5 mg) after 3 months led to decrease in systolic blood pressure by an average of 39.5 mm Hg, diastolic - 18.7 per mm Hg. The frequency of achieving the target BP <140 mm Hg and 90 it was 76%. Marked reduction in BP and frequency to achieve the target BP is not dependent on additional training of physicians and patients, the use of prior therapy in free or fixed combination, but depended on the initial degree of increase in BP and duration of therapy. Predictors of failure to achieve target BP were age, male gender, low initial adherence, good health, a higher baseline BP, elevated cholesterol levels, body weight, heart rate and decreased glomerular filtration rate. Adherence to therapy patients (on a scale of Morisky-Green) and health assessment on a visual analog scale significantly increased. This tactic has been a change of therapy is not only effective but also safe. Adverse events were reported in 28 patients (1.4% of the total number of observed cases) and only 1 case required dose reduction due to development of clinically manifested hypotension.In enhancing the effectiveness of the treatment of patients with hypertension was decisive simplification of drug therapy through the use of a fixed combination of perindopril A/indapamide.