Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2012, 21(4):308-315

New directions in guidelines on hypertension treatment : are fixed-dosed combinations of antihypertensive drugs an advantage?

Remková A
Centrum hemostázy a trombózy, HemoMedika Bratislava, s.r.o. v Bratislave, Slovenská republika

In most hypertensive patients, more than one antihypertensive compound is necessary to achieve the target level of blood pressure (BP). Combining two antihypertensive agents from two different classes results in a greater BP reduction than doubling the dose of one agent. It is also applicable for treatment initiation, especially in patients at high cardiovascular risk. This strategy is reflected in current guidelines on hypertension treatment. Although several two-drug combinations are suitable for clinical use, evidence of risk of cardiovascular events and death reduction from recent large-scale trials differs from one combination to another. The best evidence comes from outcome studies with an ACE inhibitor and dihydropyridine calcium antagonist combination, that of perindopril/ amlodipine, particularly in the ASCOT trial. The combination of an ACE inhibitor plus thiazide-like diuretic such as perindopril/indapamide is also supported by favourable results from large-scale trials (PROGRESS, ADVANCE and HYVET). Whenever it is possible, fixed-dose combinations (e.g. perindopril arginine/amlodipine or perindopril arginine/ indapamide) rather than individual drugs should be used.

Keywords: combination therapy; arterial hypertension; perindopril arginine, amlodipine; perindopril arginine, indapamide; fixed-dosed combinations

Published: April 1, 2012  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Remková A. New directions in guidelines on hypertension treatment : are fixed-dosed combinations of antihypertensive drugs an advantage? Cardiology Letters. 2012;21(4):308-315.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Sever PS, Messerli FH. Hypertension management 2011: optimal combination therapy. Eur Heart J 2011;32(20):2499-2506. Go to original source...
    2. Ruschitzka F. Evidence from improvement in survival with antihypertensive combination treatment. J Hypertens 2011;29(Suppl. 1):S9-S14. Go to original source...
    3. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010;375:895-905. Go to original source...
    4. Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet 2010;375:906-915. Go to original source...
    5. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A; European Society of Hypertension; European Society of Cardiology. 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 2007;16:135-232. Go to original source...
    6. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfied MJ, Cifkova R, Clement D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HA, Van Zwieten PA, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension managements: a European Society of Hypertension Task Force document. J Hum Hypertens 2009;27:2121-2158. Go to original source...
    7. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-1252. Go to original source...
    8. Mourad JJ. Which patients benefit the most from the perindopril/amlodipine combination. J Hypertens 2011;29(Suppl1):S23-S28. Go to original source...
    9. National Collaborating Centre for Chronic Conditions: Hypertension. Management of Hypertension in Adults in Primary Care: Partial Update. NICE Clinical Guideline. London, United Kingdom: Royal College of Physicians; 2006.
    10. National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 127 Hypertension: Clinical management of primary hypertension in adults. August 2011 www.nice.org. uk/guidance/CG127.
    11. Remko M. Acidity, lipophilicity, solubility, absorption, and polar surface area of some ACE inhibitors. Chem Papers 2007;61:133141. Go to original source...
    12. Remko M. Molecular structure and stability of perindopril erbumine and perindopril L-arginine complexes. Eur J Med Chem 2009;44:101-108. Go to original source...
    13. Remko M, Bojarska J, Ježko P, Sieroń L, Olczak A, Maniukiewicz W, Crystal and molecular structure of perindopril erbumine salt. J Mol Struct 2011;997:103-109. Go to original source...
    14. Remková A, Kratochvíľová H, Ďurina J. Impact of the therapy by renin-angiotensin system targeting antihypertensive agents perindopril versus telmisartan on prothrombotic state in essential hypertension. J Hum Hypertens 2008;22(5):338-345. Go to original source...
    15. Remková A, Remko M. The role of renin-angiotensin system in prothrombotic state in essential hypertension. Physiol Res 2010;59(1):13-23. Go to original source...
    16. Remková A, Remko M. El Sistema Renina-Angiotensina-Aldosterona (SRAA) y el Estado Protrombótico en la Hipertensión Arterial. Salud(i)Ciencia 2011;18(3):220-224.
    17. Sever PS, Poulter NR. Management of hypertension: is it the pressure or the drug? Blood pressure reduction is not the only determinant of outcome. Circulation 2006;113:2754-2774. Go to original source...
    18. Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H; LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:995-1003. Go to original source...
    19. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J; for the ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes TrialBlood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005;366:895-906. Go to original source...
    20. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ; ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. NEJM 2008;359:2417-2428. Go to original source...
    21. Julius S, Kjeldsen SE, Brunner H, Hansson L, Platt F, Ekman S, Laragh JH, McInnes G, Schork AM, Smith B, Weber M, Zanchetti A; VALUE Trial. VALUE trial: Long-term blood pressure trends in 13,449 patients with hypertension and high cardiovascular risk. Am J Hypertens 2003;7:544-548. Go to original source...
    22. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke M; CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006;113:1213-1225. Go to original source...
    23. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Poulter NR, Sever PS; on behalf of the ASCOT-BPLA and MRC Trial Investigators. Effects of beta-blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol 2010;9:469-480. Go to original source...
    24. Gupta AK, Nasothimiou EG, Chang ChL, Sever PS, Dahlöf B, Poulter NR, on behalf of the ASCOT investigators. Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk. Journal of Hypertension 2011;29:2004-2013. Go to original source...
    25. Makani H, Bangalore S, Romero J, Wever-Pinzon O, Messerli FH. Effect of renin-angiotensin-system blockade on calcium channel blockers associated peripheral edema. Am J Med 2011;124:128-135. Go to original source...
    26. Messerli FH, Bangalore S. Half a century of hydrochlorothiazide: facts, fads, fiction, and follies. Am J Med 2011;124:896-899. Go to original source...
    27. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, BanyaW, Bulpitt CJ, for the HYVET Study Group. Treatment of hypertension in patients 80 years of age and older. NEJM 2008;358:1887-1898. Go to original source...
    28. PROGRESS Collaborative Group: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033-1041. Go to original source...
    29. Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829-840. Go to original source...
    30. Neglia D, Fommei E, Varela-Carver A, Mancini M, Ghione S, Lombardi M, Pisani P, Parker H, D´amati G, Donato L, Camici P. Perindopril and indapamide reverse coronary microvascular remodelling and improve flow in arterial hypertension. J Hypertens 2011; 29(2):364-372. Go to original source...
    31. Poulter NR. A new dimension in hypertension management with the amlodipine/ perindopril combination. J Hypertens 2011;29(Suppl 1):S15-S21. Go to original source...
    32. Remková A. Klinická synergia kombinácie perindopril arginínu a amlodipínu v liečbe hypertenzie a v prevencii kardiovaskulárnych príhod u pacientov s koronárnou chorobou srdca. Cardiology Lett 2011;20(3):228-237.

    Return to the content