Improving blood pressure control, organoprotection and metabolic disorders correction in patients with hypertension switching from diuretic-based combinations to fixed combination lisinopril + amlodipine + rosuvastatin

The aim of the study was to assess the possibility of fixed combination Lisinopril + amlodipine + rozuvastatin to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous diuretic-based combination antihypertensive therapy. Materials and methods. In an open, observational study duration of 24 weeks was included 60 patients on previous diuretic-based combination antihypertensive therapy. All participants underwent 24-hour blood pressure monitoring, applanation tonometry (augmentation index and central blood pressure), pulse wave velocity measurement, laboratory tests (lipid profile, fasting glucose, insulin resistance index - NOMA), leptin, high-sensitivity C-reactive protein before and after the switching to a fixed combination of lisinopril + amlodipine + rosuvastatin. Results. According to measurements of office blood pressure switching of patients on double combinations based on diuretics to a fixed combination of lisinopril + amlodipine + rosuvastatin, a further decrease in systolic blood pressure (SBP) by 13.7% and diastolic BP (DBP) by 18.8% was observed. According to the ABPM, the decline in the average daily SBP was 15.8%, DBP - 22.5%, average SBP - 16.2%, DBP - 19.8%. The combination of lisinopril + amlodipine + rosuvastatin reduced PWV by 15.9%, augmentation index by 13.5%, central SBP by 8.4% (

Optimization of blood pressure control, organ protection and metabolic disorders using a fixed-dose combination of lisinopril+amlodipine+rosuvastatin in hypertensive patients after COVID-19

Aim. To evaluate the potential of a fixed-dose combination of lisinopril+amlodipine+rosuvastatin (Equamer®) in achieving additional vascular protection in patients with hypertension and high pulse wave velocity (PWV) after severe and very severe coronavirus disease 2019 (COVID-19), complicated by bilateral multisegmental viral pneumonia, with the use of biological therapy, who had not previously received combination antihypertensive therapy.Material and methods. This 12-week open-label observational study included 30 patients with or without antihypertensive therapy. The patients underwent 24-hour blood pressure monitoring, applanation tonometry (determination of the augmentation index (AI) and central blood pressure (CBP)), PWV measurement, blood laboratory tests (lipid profile, fasting glucose, C-reactive protein, complete blood count, ferritin, fibrinogen, D-dimer, alanine aminotransferase, aspartate aminotransferase, creatinine, uric acid) before and after switch to a fixed-dose combination of lisinopril+amlodipine+rosuvastatin.Results. At baseline, the patients had an increase in office blood pressure (BP) up to 152,6/89,1 mm Hg. After prescribing a fixed-dose combination of lisinopril+amlodipine+rosuvastatin, there was a decrease in systolic blood pressure (SBP) by 15,8% and diastolic blood pressure (DBP) by 12,2%. According to 24-hour blood pressure monitoring, the decrease in SBP was 15%, DBP — by 9%, PWV — by 23,8%, AI — by 9%, CBP — by 12,4% (p<0,05 for all compared to baseline values). Vascular age (VA) was initially increased to 41,9 years with a chronological age of 35,03 years. After the end of therapy, there was a significant decrease in VA to 36,5 years, low-density lipoproteins by 46,8%, triglycerides by 16,8% and an increase in high-density lipoproteins by 10,7% (p<0,05 for all compared to baseline values). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, and uric acid significantly decreased.Conclusion. The fixed-dosed combination of lisinopril+amlodipine+rosuvastatin provides better blood pressure control, improved vascular elasticity parameters (AI, PWV, CBP, decrease in VA), and also improves lipid and carbohydrate metabolism, reduces inflammation in patients with hypertension and hyperlipidemia after severe COVID-19

Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part II

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia

COMPARATIVE EFFECTIVENESS OF FIXED-DOSE COMBINATIONS OF LISINOPRIL/AMLODIPINE AND ENALAPRIL/HYDROCHLOROTHIAZIDE

Aim. To compare clinical effectiveness and tolerability of the fixed-dose combinations of lisinopril/amlodipine (Ekvator) and enalapril/hydrochlorothiazide (Co-renitec) in high and very-high risk patients with Stage I–II arterial hypertension, whose blood pressure (BP) levels were not normalised during the preceding antihypertensive monotherapy.Material and methods. This blind, randomised (envelope method), parallel study included 27 patients in each group. For 6 months, participants received the first medication (1 tablet a day, in the morning). After the 14-day wash-out phase, they were switched to another medication and received either Ekvator (lisinopril 10 mg plus amlodipine 5 mg) or Co-renitec (enalapril 20 mg plus hydrochlorothiazide 12,5 mg).Results. After 6 months of the treatment, more than 78% of the patients receiving Ekvator achieved target BP levels, in contrast to the participants receiving Co-renitec. Moreover, the treatment with Ekvator was associated with a significant reduction in the myocardial thickness of the posterior left ventricular wall and the carotid-femoral pulse wave velocity, as well as with a significant improvement in lipid metabolism parameters.Conclusion. Ekvator was more effective than Co-renitec in terms of antihypertensive activity, left ventricular hypertrophy reduction, and arterial elasticity improvement, as well as trough/peak ratio improvement

Effectiveness of in insulin resistance correction and the adipokines level reduction in patients with arterial hypertension in comparison with other ARBs

Aim. To assess the possibility of azilsartan medoxomil to achieve target blood pressure (BP) (less than 130/80 mm Hg), to study angioprotective features and reduction of adipokines levels and inflammatory markers in patients with hypertension and previous therapy with other ARBs.Material and methods. In open observational study with 24 weeks follow-up were included 60 patients with previous therapy (losartan or valsartan or telmisartan).All patients underwent ambulatory BP monitoring, applanation tonometry (determination of the augmentation index and central BP), measurement of the pulse wave velocity, laboratory tests (lipid profile, uric acid, fasting glucose, Homeostasis Model Assessment, homocysteine, leptin, adiponectin, highly sensitive C-reactive protein, tumor necrosis factor alpha, interleukin-6).Results. Azilsartan provided the systolic BP (29,05%, 22,5% and 8,9%) and diastolic BP reduction 18,82%, 20,46% and 8,54% (p<0,05) in patients previously treated with losartan, valsartan or telmisartan, respectively. Central systolic BP (by 25,95%, 8,78%, 11,94%), central pulse BP (by 40%, 18,38% and 19,6%), augmentation index (by 28,87%, 20,69% and 14,29%) and pulse wave velocity (by 21,57%, 24,56% and 24,92%) were decreased (p<0,05). There were positive changes in leptin, C-reactive protein, IL-6, adiponectin levels in all patients with losartan, valsartan or telmisartan initial therapy (p<0,05).Conclusion. Azilsartan medoxomil has advantages in BP control, the arterial elasticity improving, reducing of insulin-resistance and inflammation

Antihypertensive therapy in obesity

Obesity today is one of the most relevant interdisciplinary problems in healthcare and one of the key reasons for blood pressure increase. Thus, according to the Framingham Heart Study,78% of hypertension in men and 65% in women can be directly attributed to obesity [10]. Fat cells play an important role in the development of hypertension, i.e. they generate a variety of biologically active substances some of which have pressor and proinflammatory effects. Leptin is one of key substances which contributes to the increase of AP through the activation of the sympathetic nervous system and direct effect on kidneys (increased sodium reabsorption). Furthermore, obesity itself adversely affects the structure of renal tissue and increases the risk of progression of renal failure and hypertension. In addition, fatty tissue has its own renin-angiotensin system and may actively produce angiotensin

Azilsartan medoxomil for improving insulin resistance and adipokine levels in hypertension in comparison with angiotensin-converting enzyme inhibitors

Aim. To assess azilsartan medoxomil (AZM) in achieving the target blood pressure (BP) (<140/90 mm Hg), its angioprotective action in patients with hypertension (HTN), as well as contribution in reducing levels of adipokines and inflammation markers in patients switching from lisinopril or enalapril.Material and methods. This open-label observational study lasting 24 weeks included 60 patients who had previously received monotherapy with lisinopril 20 mg/day or enalapril 20 mg/day, and did not reach the target BP levels (<140/90 mm Hg).During the study, all patients underwent 24-hour BP monitoring, applanation tonometry (determination of the augmentation index and central BP), pulse wave velocity measurement, laboratory tests (lipid profile, uric acid, fasting glucose, HOMA index, homocysteine, leptin, adiponectin, highly sensitive C-reactive protein (hs-CRP), tumor necrosis factor alpha, interleukin-6 (IL-6).Results. After switching from lisinopril and enalapril to AZM, a decrease in systolic BP was 24,3% and 31,3%, diastolic BP — 19,8% and 21,4% (p<0,05). In the groups of initial therapy with lisinopril and enalapril, there was a decrease in central (aortic) BP by 20,4% and 25,5%, central pulse pressure by 20,6% and 27,6%, augmentation index by 33,1% and 34,58%, pulse wave velocity by 19,4% and 20,7% (p<0,05), levels of leptin by 10,4%, and 16,8%, hs-CRP by 16,1% and 19,3%, IL-6 by 23,6% and 25,1%, respectively. We also revealed an increase in adiponectin levels by 7,2% and 9,2%, respectively (p<0,05).Conclusion. Azilsartan medoxomil has advantages over angiotensin-converting enzyme inhibitors (enalapril, lisinopril) in achieving BP control, and improving vascular elasticity. It contributes to a decrease in insulin resistance and noninfectious inflammation

Treatment of arterial hypertension in metabolic syndrome in men with erectile dysfunction

Metabolic syndrome (MS) is a combination of hormonal, metabolic and clinical disorders, and one of the most studied subjects in the modern medicine. Today MS is considered to be a major risk factor for cardiovascular disease, disorders of carbohydrate metabolism and pathology of the reproductive system [6, 41]