Treatment of arterial hypertension with a fixed combination of ACE inhibitor, calcium channel blocker and thiazide-type diuretic. The results of the Ukrainian multicenter study ТРІУМФ-2
Article Sidebar
Main Article Content
Abstract
The aim – to study the profile of patients with uncontrolled arterial hypertension receiving simultaneously 2 or 3 antihypertensive agents, and to evaluate blood pressure control in this population after change of the treatment.
Material and methods. The multicenter open-label observational study ТРІУМФ-2 was conducted in Ukraine since November 2016 to April 2017. The study covered 3,556 patients with AH who were prescribed 2 or 3 antihypertensive drugs without sufficient effect for at least 1 month (2.4 years on average). The average values of office BP of the population in the study were 173/100 mm Hg. Almost half of the patients (48.1 %) had systolic (SBP) and / or diastolic (DBP) BP ≥ 180/110 mm Hg. For further treatment prescription of fixed combination of angiotensin-converting enzyme inhibitor (IACE), dihydropyridine calcium channel blocker (CCB) and diuretic, and if necessary, other agents and medical supervision for 3 months were proposed. The chosen drug for 3,555 patients was the original triple fixed combination of perindopril arginine, indapamide and amlodipine. The patients visited their doctors after 1 and 2 weeks, 2 and 3 months. Adherence to the treatment was assessed before and after 2 months of treatment. Furthermore, 64 % of the participants of the ТРІУМФ-2 filled in the BP control diaries.
Results. The prescription of the original triple fixed combination for 3 months was accompanied by the decrease of office BP to the target levels (<140/90 mm Hg) in 79 % of cases. The maximum dynamics of BP values was observed during the first week after the initiation of the therapy: the average changes in the parameters from the baseline were 30 mm Hg for SBP (P<0.001), and 13 mm Hg for DBP (P<0.001). This fact reflects rapid and effective action of this drug. By the end of the observation, the mean values of BP of the study population were 129/78 mm Hg. The patients who received and returned the BP control diary (97.67 %), showed significantly higher level of adherence to the treatment in comparison with the participants who did not fill in the diaries (75.83 %). Original triple combination of perindopril arginine / indapamide / amlodipine was characterized not only by the convenience of medication administration, but also by good tolerability.
Conclusions. Original triple combination of perindopril arginine / indapamide / amlodipine in average daily doses of 8.48 / 2.12 / 7.34 mg provides most significant decrease of office BP after 7 days: average SBP – 30 mm Hg (17 %) and DBP – by 13 mm Hg (13 %) with further slow decrease of BP during next 2 weeks and 2–3 months of the study among patients who took 2-3 antihypertensive drugs. Usage of the original fixed combination in patients with baseline mean BP 173/100 mm Hg for 7 days provided effective BP control in 28 % patients, after 2 weeks – in 41 %, in 2–3 months – in 71–79 % patients, regardless of the previous therapy and initial degree of BP increase.
Article Details
Keywords:
References
Коваленко В.М., Корнацький В.М., Манойленко Т.С. та ін. Проблеми здоров’я і медичної допомоги та модель покращання в сучасних умовах. – К., 2016.– 261 с.
Лутай М.І. Ефективність комбінованої терапії артеріальної гіпертензії в Україні: результати багатоцентрового дослідження ТРІУМФ // Укр. кардіол. журн.– 2016.– № 4.– С. 17–27.
Настанова та клінічний протокол надання медичної допомоги «Артеріальна гіпертензія». Наказ МОЗ України № 384 від 24.05.2012.
Серцево-судинні захворювання. Класифікація, стандарти діагностики та лікування / За ред. В.М. Коваленка, М.І. Лутая, Ю.М. Сіренка, О.С. Сичова.– К.: Моріон, 2016.– С. 10–13; 59–76.
Уніфікований клінічний протокол. Первинної, екстреної та вторинної (спеціалізованої) медичної допомоги. Артеріальна гіпертензія.– 2016.
ADVANCE Collaboration Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE study): a randomized controlled trial // Lancet.– 2007.– Vol. 370.– P. 829–840.
Amar J., Chamontin B., Genes N. et al. Why is hypertension so frequently uncontrolled in secondary prevention? // J. Hypertens.– 2003.– Vol. 21.– P. 1199–1205.
Chowdhury R., Khan H., Heydon E. et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences // Eur. Heart J.– 2013.– Vol. 34 (38).– P. 2940–2948.
Corrao G., Zambon A., Parodi A. et al. Discontinuation and changes in drug therapy for hypertension among newly treated patients: a population-based study in Italy // J. Hypertens.– 2008.– Vol. 26.– P. 819–824.
Czernichow S., Zanchetti A., Turnbull F. et al. The effects of blood pressure reduction and of different blood pressure-
lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials // J. Hypertens.– 2011.– Vol. 29.– P. 4–16.
Dalhof B., Sever P., Poulter N. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required vs atenolol adding bendroflumethiazide as required in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) a multicenter randomized controlled trial // Lancet.– 2005.– Vol. 366.– P. 895–906.
ESH/ESC Guidelines for the management of arterial hypertension // Eur. Heart J.– 2013.– Vol. 34.– P. 2159–2219.
Nayler W. Amlodipine.– Berlin: Springer-Verlag, 1993.– 277 p.
Opie L., Gersh B. Drugs for Heart.– Elservier Inc, 2005.– 437 p.
Verdecchia P., Reboldi G., Angeli F. et al. Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease and stroke prevention // Hypertension.– 2005.– Vol. 46.– P. 386–392.
Wald D., Law M., Morris J. et al. Combination therapy vs monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials // Am. J. Med.– 2009.– Vol. 122.– P. 290–300.
Xie L., Frech-Tamas F., Marrett E., Baser O. A medication adherence and persistence comparison of hypertensive patients treated with single-, double- and triple-pill combination therapy // Curr. Med. Res. Opin.– 2014.– Vol. 26.– P. 2415–2422.