[PP.15.12] THE EFFECT OF PERINDOPRIL/AMLODIPINE FIXED-DOSE COMBINATION ON THE HEMODYNAMIC VARIABILITY IN HYPERTENSIVE PATIENTS WITH HIGH CARDIOVASCULAR RISK
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Objective: The measured and calculated values of blood pressure (BP) recorded by ambulatory blood pressure monitoring (ABPM) [mean 24-hour BP, daytime BP, nighttime BP, diurnal pattern, BP variability visit by visit (standard deviation, coefficient of variation), vascular elasticity characterized by ambulatory arterial stiffness index (AASI)] are more appropriate predictors of long-term cardiovascular morbidity and mortality than office-based BP measurement. Design and method: The BP-reducing effect of the fix-dose combination perindopril/amlodipine (5 mg/5 mg, 5 mg/10 mg, 10 mg/5 mg, 10 mg/10 mg) was investigated in hypertensive patients with high cardiovascular risk from the ABPM subgroup of the large Hungarian trial, the PErindopril/Amlodipine Reduction of blood pressure Level study (PEARL). ABPM was performed in 262 patients (from 10335) (144 males, average age 60,4 ± 11,7 years) at the first- and at the 3-months visit. Data were presented as mean ± SD. For comparisons of BP measurements one sample t-test and Chi-square test were performed. A 2-sided α level of 0.05 was considered statistically significant. Results: The fixed combination perindopril/amlodipine reduced the mean office BP from 159.8/94.3 mmHg to 131.0/80.0 mmHg (p < 0.001) and the 24-hour BP from 146.1/84.3 mmHg to 127.6/75.9 mmHg (p < 0.001) in the ABPM subgroup. The diurnal pattern was not changed. The SD dropped from 15.3/11.4, to 10.5/8.9 (p < 0.01) and the CV from 10.5/13.5% to 8.2/11.7 % (p < 0.01). The AASI also decreased from 0.4571 ± 0.11 to 0.4168 ± 0.12 (p < 0.01). Conclusions: The results of our study show a significant and safety BP reduction in office as well as in ABPM in hypertensive patients with high cardiovascular risk and whose BP was uncontrolled by a suitable previous treatment. In our study we were able to illustrate a higher BP variability at the first visit compared with the 3 months visit. In addition we found an AASI reduction (which might reflect arterial rigidity). These rapid changes, observed in our study, might correlate with the results of the randomized, controlled ASCOT-BPLA study and are appropriate to predict the cardiovascular morbidity and mortality.Keywords:
Perindopril
Amlodipine
Dipper
Coefficient of variation
In the recent Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm trial, the amlodipine ± perindopril strategy resulted in fewer deaths and cardiovascular events than an atenolol ± thiazide strategy. Because of the intrinsic properties of both angiotensin-converting enzyme inhibitors, particularly in terms of secondary prevention of ischaemic heart disease, and calcium-channel blockers, in terms of anti-anginal properties, the combination of amlodipine and perindopril should prove particularly beneficial in patients with coronary artery disease and either hypertension or anginal symptoms. In addition, both classes of medications have a favourable metabolic profile and have been shown to reduce the occurrence of new-onset diabetes mellitus in a variety of clinical situations. Finally, the impact of the amlodipine ± perindopril combination on central aortic pressure suggests a particular relevance in situations of increased central pulse pressure, such as elderly populations or patients with chronic kidney disease. Therefore, the amlodipine ± perindopril combination is likely to offer important clinical benefits in a number of fairly common clinical conditions.
Amlodipine
Perindopril
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Objective:To investigate the changes of plasma endothelin (ET), nitric oxide (NO), neuropeptide(NPY) and angiotension Ⅱ (Ang Ⅱ) levels in elderly non dipper hypertension patients before and after amlodipine therapy.Method:There were 42 elderly patients with non dipper hypertensive. Before and after amlodipine therapy, the serum ET, NO, NPY and Ang Ⅱ levels were tested.Result: ET, NPY and Ang Ⅱ levels were higher in non dippers than those in dippers, NO level was lower in both groups.Amlodipine could significantly lower systolic Bp, but had a little effect on noctural dBp. The plasma ET and NPY levels were decreased after treatmeat in non dipper group. NO level was increased markedly and there was no significant change of AngⅡ after amlodipine.Conclusion:ET, NO, NPY and Ang Ⅱ might be involved in the mechanism of non dipper hypertension in elderly, and amlodipine seems to be an effective drug for elderly non dippers.
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Amlodipine
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A systematic review identified 86 outcome‐based clinical trials involving perindopril, amlodipine, or other antihypertensive drugs. In fixed‐effects meta‐analyses of 11 clinical trials (90,208 subjects), amlodipine was associated with a significant 24% increase in heart failure, but a significant decrease in death, cardiovascular death, stroke, coronary heart disease, and first major cardiovascular adverse event. In five clinical trials (52,565 subjects), perindopril was associated with a significant reduction in all six cardiovascular endpoints. Network and Bayesian meta‐analyses suggested that (with the exception of amlodipine and heart failure), each agent was at least as effective as an initial diuretic to prevent these events. Short‐term trials have demonstrated that the combination of perindopril and amlodipine is safe and effective, with statistically greater lowering of blood pressure than either agent alone and a potential synergistic effect on pedal edema. The single‐pill combination of perindopril and amlodipine may be a useful addition to the antihypertensive armamentarium. J Am Soc
Amlodipine
Perindopril
Stroke
Pill
Indapamide
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Dipper
White coat hypertension
Masked Hypertension
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Objective The discussion Perindopril and amlodipine besylate union treatment primary hypertension curative effect.Methods Divides into the treatment group and the control group stochastically 80 example primary patients with elevated blood pressure,the control group 40 examples uses Perindopril,the treatment group 40 examples Perindopril's foundation in the application to add with the amlodipine besylate,observes two groups of medicines to hypertension curative effect.Results Treatment group total effectiveness 90%,control group total effectiveness 77.5%,two groups of differences remarkable(P0.05).Conclusion Perindopril and amlodipine besylate treat hypertension curative effect affirmation jointly,responds not good few,is worth promoting.
Perindopril
Amlodipine
Hypertension treatment
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Perindopril
Amlodipine
Fixed-dose combination
Essential hypertension
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Amlodipine
Perindopril
Stroke
Pill
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A new rapid, precise and sensitive reverse phase high performance liquid chromatographic (RP-HPLC) method has been developed and validated for the estimation of Perindopril and Amlodipine simultaneously in combined dosage form. The two components Perindopril and Amlodipine were well resolved on an isocratic method, C18 column, utilizing a mobile phase composition of acetonitrile: methanol: a mixed buffer of 0.02M Potassium dihydrogen phosphate buffer and 0.02M Sodium dihydrogen Phosphate buffer with 1mL Tri ethyl amine (40:20:40), v/v, pH 5.0) at a flow rate of 1.0 mL/min with UV detection at 226 nm. The retention time of Perindopril and Amlodipine were 2.9 min and 4.9 min respectively. The developed method was validated for specificity, linearity, precision, accuracy, limit of detection (LOD), limit of quantification (LOQ) and robustness as per ICH guidelines. Linearity for Perindopril and Amlodipine were found in the range of 48-112 µg/ml and 60.0-140.0 µg/ml, respectively. The percentage recoveries for Perindopril and Amlodipine ranged from 98.9-100.4 % and 98.9-100.7 %, respectively. The proposed method could be used for routine analysis of Perindopril and Amlodipine in their combined dosage forms.
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Perindopril
Phosphate buffered saline
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Objective: The objective of this research was to perform a prospective clinical trial to compare antihypertensive effects of amlodipine and perindopril in hypertensive patients.Methods: In our study, we compared antihypertensive effects of well tolerated and commonly used antihypertensive drugs, amlodipine and perindopril. There were 81 hypertensive patients of both sexes over 40 y of age without other diseases included in this prospective clinical trial. Forty (40) patients were treated with amlodipine (5 mg/day) and forty-one (41) patients were treated with perindopril (4 mg/day). After one month of taking both drugs, blood pressure was measured in the supine position with a standard mercury sphygmomanometer in the morning.Results: Amlodipine and perindopril groups were having almost similar characteristics at the beginning of the study. There was significantly decrease insystolic blood pressure (sBP) throughout the study period in the amlodipine group (p≤ 0.05) but not in the perindopril group. The efficacy of amlodipine over perindopril on systolic blood pressure and diastolic blood pressure (dBP) was significant (p≤ 0.001 for sBP and p≤ 0.05 for dBP).Conclusion: It may be concluded that the antihypertensive efficacy of amlodipine was superior when compared to perindopril.
Perindopril
Amlodipine
Supine position
Essential hypertension
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Objective: The purpose of this study was to assess in real practice the effect on adherence of a switch from a single- or two-pills therapy (SPT/FC) of perindopril and/or amlodipine to fixed-dose combination (FDC) of the same drugs. Methods: This was a retrospective cohort study, performed in 3 Italian Local Health Units. We selected all subjects ? 18 years, who received at least one prescription of antihypertensive drugs between 01/01/2010 and 31/12/2014. For each patient we evaluated the adherence to different schedule of perindopril/amlodipine administration schedule during the two 12-month periods preceding and following the index date. We also evaluated the rate of major CV events, the changes in concomitant treatment and the economic implications of drugs switch. Changes in adherence level had been compared in subjects who shifted to the FDC of perindopril/amlodipine after the ID as well as in patients who did not. Design and method: A total of 24,020 subjects were analyzed. Subjects treated with the free dose combination switched more frequently to FDC of to perindopril/amlodipine than subjects treated with SPT (p < 0.001). Adherence to treatment was higher in the 3,597 subjects who switched to the perindopril/amlodipine FDC therapy, than in the 20,423 subjects who did not. The rate of major CV events was lower in patients with adherence > 80% who also showed a higher rate of concomitant treatment reduction (36.5% vs. 21.3%; p = 0.005). No differences have been observed in the drug costs after switch. Results: Our results show that, the real-world use of perindopril/amlodipine as FDC increases the rate of stay-on-therapy, improves the antihypertensive drug schedule and reduces the rate of major CV events in subjects previously treated with the same drugs as a two pills combination or as SPT.
Perindopril
Amlodipine
Concomitant
Fixed-dose combination
Combination therapy
Pill
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