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Effectiveness of Fixed-Dose Perindopril/Amlodipine on Clinic, Ambulatory and Self-Monitored Blood Pressure and Blood Pressure Variability: An Open-Label, Non Comparative Study in the General Practice

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Abstract

Introduction

Fixed-dose combinations (FDCs) of antihypertensive agents improve therapeutic efficacy, according to current guidelines and large clinical studies.

Aim

This Russian study examined the effect on blood pressure (BP) of substituting current ineffective antihypertensive treatment with FDC perindopril/amlodipine in patients with uncontrolled hypertension.

Methods

BP was measured in the doctor’s office at each visit, daily at home, and by ambulatory monitoring (ABPM) at inclusion and end-of-study.

Results

Ninety patients (52.7 ± 12.2 years old; mean baseline BP 161.4/94.9 mmHg) at high or very high cardiovascular risk were included. FDC perindopril/amlodipine (5/5, 10/5 or 10/10 mg) exerted a rapid (2 weeks) and significant (p < 0.001) reduction in clinic BP, maintained after 3 months (−33.7/17.1 mmHg). ABPM and home monitoring showed that BP decrease remained significant throughout the study (p < 0.0001). BP variability was reduced, indicating the stable and homogeneous 24-h antihypertensive effect of FDC perindopril/amlodipine. Quality of life and adherence were also improved.

Conclusions

The three main methods of BP assessment showed that substituting ineffective antihypertensive therapy with FDC perindopril/amlodipine resulted in a rapid and pronounced antihypertensive effect, with target BP levels achieved after 3 months in most patients. This beneficial effect was observed also on various parameters related to BP variability, which may reflect additional cardioprotective properties.

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References

  1. Mathers C, Stevens G, Mascarenhas M. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva; 2009. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf.

  2. Harmon L, Chilton RJ, Spellman C. Reducing cardiovascular events and end-organ damage in patients with hypertension: new considerations. Postgrad Med. 2011;123(2):7–17.

    Article  PubMed  Google Scholar 

  3. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of ESH and of ESC. Eur Heart J. 2013;34(28):2159–219.

    Article  PubMed  Google Scholar 

  4. Go AS, Bauman MA, King SMC, et al. An effective approach to high blood pressure control. A science advisory from AHA, ACC, and the Centers for Disease Control and Prevention. Hypertension. 2014;63(4):878–85.

    Article  CAS  PubMed  Google Scholar 

  5. James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  PubMed  Google Scholar 

  6. Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. New Engl J Med. 2003;348:2407–15.

    Article  PubMed  Google Scholar 

  7. Dolan E, Stanton AV, Thom S, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients—an Anglo-Scandinavian cardiac outcomes trial substudy. J Hypertens. 2008;27:876–85.

    Article  Google Scholar 

  8. Rothwell PM, Howard SC, Dolan E, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure and episodic hypertension. Lancet. 2010;375:895–905.

    Article  PubMed  Google Scholar 

  9. Oganov RG, Timofeev TN, Koltunov IE, et al. Epidemiology of hypertension in Russia. The results of 2003–2010 federal monitoring. Cardiovasc Ther Prev. 2011;10:9–13.

    Google Scholar 

  10. Dallongeville J, Banegas JR, Tubach F, et al., For the EURIKA Study. Survey of physicians’ practices in the control of cardiovascular risk factors: the EURIKA study. Eur J Prev Cardiol. 2012;19(3):541–50.

  11. Prugger C, Keil U, Wellman J, et al., For the EUROASPIRE III. Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens. 2011;29(8):1641–8.

  12. Bramlage P, Böhm M, Volpe M, et al., For the ISEARCH Study. A global perspective on blood pressure treatment and control in a referred cohort of hypertensive patients. J Clin Hypertens (Greenwich). 2010;12(9):666–77.

  13. Tocci G, Ferrucci A, Pontremoli R, et al. Blood pressure levels and control in Italy: comprehensive analysis of clinical data from 2000–2005 and 2005–2011 hypertension surveys. J Hum Hypertens. 2015. doi:10.1038/jhh.2015.4.

    Google Scholar 

  14. Karpov YA, Deev AD, On behalf of the doctors participating in the program PRORYV. Uncontrolled hypertension—new opportunities in solving the problem of increasing the effectiveness of treatment. Kardiologija. 2012;2:29–35.

    Google Scholar 

  15. Russian Medical Society of Hypertension, Russian Scientific Society of Cardiology. Diagnosis and treatment of hypertension. Russian recommendations (fourth revision); 2010.

  16. Longo D, Toffanin G, Garbelotto R, et al. Performance of the UA-787 oscillometric blood pressure monitor according to the European Society of Hypertension protocol. Blood Press Monit. 2003;8(2):91–5.

    Article  PubMed  Google Scholar 

  17. Rogoza AN, Nikolsky VP, Oshchepkova EV, et al. Ambulatory blood pressure monitoring in hypertension: methodological issues; 2005.

  18. Rizzoni D, Castellano M, Muiesan ML. Beyond trough-to-peak ratio: a new index of the smoothness of the antihypertensive effect of a drug. High Blood Press. 1997;6:110–5.

    Google Scholar 

  19. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    Article  CAS  PubMed  Google Scholar 

  20. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348–54.

    Article  Google Scholar 

  21. Sever PS, Dahlof B, Poulter NR, et al., 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 Trial (ASCOT-BPLA): a multicenter randomized controlled trial. Lancet. 2005;366(9489):895–906.

  22. Rodriguez-Granillo GA, Vos J, Bruining N, et al., Investigators of the EUROPA Study. Long-term effect of Perindopril on coronary atherosclerosis progression (from the PERindopril’s Prospective Effect on Coronary aTheroslerosis by Angiography and IntraVascular Ultrasound Evaluation [PERSPECTIVE] Study). Am J Cardiol. 2007;100(2):159–63.

  23. Tropeano AI, Boutouyrie P, Pannier B, et al. Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives. Hypertension. 2006;48:80–6.

    Article  CAS  PubMed  Google Scholar 

  24. Williams B, Lacy PS, Thom SM, et al., 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 evaluation (CAFE) study. Circulation. 2006;113(9):1213–25.

  25. Kobalava ZhD, Kotovskaya Y, Lukyanova L, et al. Combination therapy of hypertension fixed combination of perindopril arginine/amlodipine in clinical practice: the organization and the main results of the program KONSTANTA. Kardiologija. 2013;6:25.

    Google Scholar 

  26. Bahl VK, Jadhav UM, Thacker HP. Management of hypertension with the fixed combination of perindopril and amlodipine in daily clinical practice. Results from the STRONG prospective, observational, multicenter study. Am J Cardiovasc Drugs. 2009;9(3):135–42.

    Article  CAS  PubMed  Google Scholar 

  27. Hatala R, Bachanova K, Sidlo R, SYMBIO Investigators. SYMBIO: results of a longitudinal study of optimized blood pressure lowering therapy with fixed combination perindopril/amlodipine. J Hypertens. 2010;28:e98–9.

    Article  Google Scholar 

  28. Karpov YA. Achieving the target blood pressure in patients with hypertension uncontrolled when translating from mono- or combination therapy for a fixed combination of an ACE inhibitor and a calcium antagonist. Arter Hypertens. 2012;18(6):484.

    Google Scholar 

  29. Boggia J, Li Y, Thijs L, et al. Prognostic accuracy of day vs. night ambulatory blood pressure: a cohort study. Lancet. 2007;370(9594):1219–29.

    Article  PubMed  Google Scholar 

  30. Fagard RH, Celis H, Thijs L, et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension. 2008;51(1):55–61.

    Article  CAS  PubMed  Google Scholar 

  31. Bliziotis IA, Destounis A, Stergiou GS. Home versus ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis. J Hypertens. 2012;30(7):1289–99.

    Article  CAS  PubMed  Google Scholar 

  32. Stergiou G, Siontis KC, Ioannidis JP. Home blood pressure as a cardiovascular outcome predictor: it’s time to take this method seriously. Hypertension. 2010;55(6):1301–3.

    Article  CAS  PubMed  Google Scholar 

  33. Fagard RH, Van Den Broeke C, De Cort P. Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens. 2005;19(10):801–7.

    Article  CAS  PubMed  Google Scholar 

  34. Mancia G, Facchetti R, Bombelli M, et al. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47(5):846–53.

    Article  CAS  PubMed  Google Scholar 

  35. Kobalava ZD, Kotovskaya IV, Lukyanova EA, On behalf of the participants in the program KONSTANTA. Combination therapy of hypertension with the fixed combination of perindopril arginine/amlodipine in clinical practice: the organization and the main results of the study. Kardiologija. 2013;53(6):25–34.

    Google Scholar 

  36. Schillaci G, Pucci G, Parati G. Blood pressure variability. An additional target for antihypertensive treatment. Hypertension. 2011;58:133–5.

    Article  CAS  PubMed  Google Scholar 

  37. Poulter NR. Blood pressure variability: a new challenge in blood pressure measurement. In: Bakris GL, Bertrand M, Blacher J, et al., editors. Improving management of hypertension: reconsidering efficacy assessment. Berlin: Springer Science; 2012. p. 35–46.

    Google Scholar 

  38. Mancia G. Short- and long-term blood pressure variability. Present and future. Hypertension. 2012;60(2):512–7.

    Article  CAS  PubMed  Google Scholar 

  39. Parati G, Bilo G. Calcium antagonist added to angiotensin receptor blocker: a recipe for reducing blood pressure variability? Evidence from day-to-day home blood pressure monitoring. Hypertension. 2012;59:1091–3.

    Article  CAS  PubMed  Google Scholar 

  40. Muntner P, Schimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension. 2011;57:160–6.

    Article  CAS  PubMed  Google Scholar 

  41. Matsui Y, O’Rourke MF, Hoshide S, et al. Combined effect of angiotensin II receptor blocker and either a calcium channel blocker or diuretic on day-by-day variability of home blood pressure. Hypertension. 2012;59:1132–8.

    Article  CAS  PubMed  Google Scholar 

  42. Matsumoto A, Satoh M, Kikuya M, et al. Day-to-day variability of blood pressure is associated with cognitive decline. The Ohasama study. Hypertension. 2014;63(6):1333–8.

    Article  CAS  PubMed  Google Scholar 

  43. Parati G, Ochoa J, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.

    Article  PubMed  Google Scholar 

  44. Parati G, Omboni S, Rizzoni D, et al. Smoothness index: a new, reproducible and clinically relevant measure of the homogeneity of the blood pressure reduction with treatment for hypertension. J Hypertens. 1998;16:1685–91.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Federal State Institution “Russian Cardiology Scientific and Industrial Complex”, 3rd Cherepkovskaya St. 15A, Moscow, 121552, Russia

    Yuri A. Karpov

  2. National Research Center for Preventive Medicine, Moscow, Russia

    Vladimir M. Gorbunov & Alexander D. Deev

Authors
  1. Yuri A. Karpov
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  2. Vladimir M. Gorbunov
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  3. Alexander D. Deev
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Corresponding author

Correspondence to Yuri A. Karpov.

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On behalf of the participants in the PRORYV-2 study.

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Karpov, Y.A., Gorbunov, V.M. & Deev, A.D. Effectiveness of Fixed-Dose Perindopril/Amlodipine on Clinic, Ambulatory and Self-Monitored Blood Pressure and Blood Pressure Variability: An Open-Label, Non Comparative Study in the General Practice. High Blood Press Cardiovasc Prev 22, 417–425 (2015). https://doi.org/10.1007/s40292-015-0117-0

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