Profiles of patients in whom it is worth using perindopril with indapamide to treat hypertension – case reports Case report series

Main Article Content

Dominika Dąbrowska
Artur Mamcarz

Abstract

Hypotensive therapy consists of many elements. Apart from drug therapy, one of the most important ones are lifestyle changes. Every patient with recognized hypertension should aim to reach target values of blood pressure through regular exercise, proper diet, weight reduction and other. If those methods are insufficient, we implement pharmacotherapy. Optimal antihypertensive treatment relies on adjusting drug scheme to patients’ profiles. While taking into consideration various aspects, including comorbidities and patient’s age, we should chose drugs to minimalize side effects and properly regulate blood pressure. In practice, hypotensive therapy is often based on polytherapy. To reach target blood pressure, we frequently use two or more antihypertensive medecines. Combination drugs have been on the market for several years now. They have positive influence on compliance and they improve treatment effects. Using two or more drugs helps exploit different active mechanisms, maximizing treatment tolerance, reducing doses and, what is most important, it enables the patients to take only one tablet. One of this types of combination is perindopril with indapamide, which has multiple applications. Elderly patients usually suffer from isolated systolic hypertension and chronic kidney disease, so the most favoured drug combination is ACEI with thiazide and thiazide-like diuretics. This therapy is also recommended in patients with diabetes, especially with concomitant microalbuminuria, because of its nephroprotective effect and in patients with recognized chronic kidney disease. Furthermore, combination of those two substances can be advantageous in patients after stroke due to proved positive action in prevention of stroke and in reaching optimal blood pressure. The treatment methods proposed show many problems and challenges of general practitioners. Family doctors choosing antihypertensive therapy have to take under consideration a number of aspects, such as patients’ general condition, drug tolerance and comorbidities.

Article Details

How to Cite
Dąbrowska, D., & Mamcarz , A. (2015). Profiles of patients in whom it is worth using perindopril with indapamide to treat hypertension – case reports. Medycyna Faktow (J EBM), 8(4(29), 6-13. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2277
Section
Articles

References

1. Beckett N.S, Peters R., Fletcher A.E. et al.: Treatment of Hypertension, in patients 80 years of age or older. N. Engl. J. Med. 2008; 358(18): 1887-1898.
2. Zanchetti A., Grassi G., Mancia G.: When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical re-appraisal. J. Hypertens. 2009; 27(5): 923-934.
3. Mancia G., Laurent S., Agabiti-Rosei E. et al.: Reappraisal of European guidelines on Hypertension, management: a European Society of Hypertension, Task Force document. J. Hypertens. 2009; 27: 2121-2158.
4. Tykarski A., Narkiewicz K., Gaciong Z. et al.: Zasady postępowania w nadciśnieniu tętniczym – 2015 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego – wersja skrócona. Kardiologia Polska 2015; 73(8): 676-700.
5. Turnbull F., Neal B., Ninomiya T. et al.; Blood Pressure Lowering Treatment Trialists’ Collaboration: Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomized trials. BMJ 2008; 336(7653): 1121-1123.
6. SHEP Co-operative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265(24): 3255-3264.
7. Staessen J.A., Fagard R., Thijs L. et al.: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350(9080): 757-764.
8. Schmieder R.E., Hilgers K.F., Schlaich M.P., Schmidt B.M.: Renin-angiotensin system and cardiovascular risk. Lancet 2007; 369(9568): 1208-1219.
9. Kunz R., Friedrich C., Wolbers M., Mann J.F.: Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann. Intern. Med. 2008; 148(1): 30-48.
10. Ruggenenti P., Fassi A., Ilieva A.P. et al.: Effects of verapamil added-on trandolapril therapy in hypertensive type 2 diabetes patients with microalbuminuria: the BENEDICT-B randomized trial. J. Hypertens. 2011; 29(2): 207-216.
11. Zoungas S., Chalmers J., Neal B. et al.; ADVANCE-ON Collaborative Group: Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N. Engl. Med. 2014; 371(15): 1392-1406.
12. Holman R.R., Paul S.K., Bethel M.A. et al.: Long-term follow-up after tight control of blood pressure in type 2 diabetes. N. Engl. J. Med. 2008; 359: 1565-1576.
13. Jafar T.H., Stark P.C., Schmid C.H. et al.: Progression of chronic kidney disease: the role of blood pressure control, proteinuria and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann. Intern. Med. 2003; 139(4): 244-252.
14. Bakris G.L., Serafidis P.A., Weir M.R. et al.; ACCOMPLISH Trial Investigators: Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of randomised controlled trial. Lancet 2010; 375(9721): 1173-1181.
15. PATS Collaborating Group: Post-stroke antihypertensive treatment study. A preliminary result. Chin. Med. J. (Engl.) 1995; 108(9): 710-717.
16. 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(9287): 1033-1104.
17. 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; 46(2): 386-392.

Most read articles by the same author(s)

1 2 > >>