Combined antihypertensive therapy as the basis for the treatment of arterial hypertension: review of the application of azilsartan medoxomil and chlorthalidon combination


DOI: https://dx.doi.org/10.18565/therapy.2019.5.127-134

Khripunova I.G., Khripunova A.A., Boeva O.I.

Stavropol State medical University of the Ministry of Healthcare of Russia
The article presents an analytical review of Russian and foreign studies of the use of a fixed combination of azilsartan medoxomil and chlorthalidon in the treatment of arterial hypertension. According to the recommendations of the European Society of Cardiology (ESС)/ European Society of Arterial Hypertension (ESH) for the treatment of arterial hypertension in 2018, the initial indicators of target values of blood pressure in the initial appointment of antihypertensive therapy in all patients should be <140/90 mm Hg. With good tolerability, in most patients during treatment, it is advisable to lower systolic blood pressure to 130 mm Hg and below, and diastolic blood pressure up to 70–79 mm Hg. In connection with new target levels of blood pressure, their control is a difficult task, and most patients will need starting combination antihypertensive therapy. Traditional initial monotherapy and a step-by-step approach led to the fact that too many patients remained on monotherapy, which led to poor control of blood pressure indicators (more than half of the patients did not reach the target levels), while «multi-tabs» therapy also gives poor results due to a decrease in compliance to treatment, and is one of the factors of poor control of pressure indicators. In this connection, it is of interest to determine the location of a fixed combination of azilsartan medoxomil and chlorthalidon in the algorithm for treating patients with hypertension.
Keywords: target blood pressure levels, a fixed combination of azilsartan and chlorthalidon, systemic arterial hypertension
Read entire article

Literature


  1. Ettehad D., Connor A.E., Kiran A. et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387(10022): 957–67. doi:10.1016/S0140–6736(15)01225-8.

  2. Kjeldsen S.E., Messerli F.H., Chiang C.E. et al. Are fixed-dose combination antihypertensives suitable as first-line therapy? Curr Med Res Opin. 2012; 28(10): 1685–97. doi:10.1185/03007995.2012.729505.

  3. MacDonald T.M., Williams B., Webb D.J. et al. Combination therapy is superior to sequential monotherapy for the initial treatment of hypertension: a double blind randomized controlled trial. J Am Heart Association. 2017; 6: e006986. doi:10.1161/JAHA.117.006986.

  4. Чазова И.Е., Жернакова Ю.В., Блинова Н.В., Рогоза А.Н. Новый блокатор рецепторов ангиотензина II Эдарби® как часть патогенетического лечения артериальной гипертонии у больных с метаболическими нарушениями. Системные гипертензии. 2017; 14(3): 3–10.

  5. Недогода С.В., Чумачек Е.В, Цома В.В., Саласюк А.С., Смирнова В.О., Попова Е.А. Возможности азилсартана в коррекции инсулинорезистентности и уровня адипокинов при артериальной гипертензии в сравнении с другими сартанами. Российский кардиологический журнал. 2019; 1: 70–79. doi.org/10.15829/1560-4071-2019-1-70-79.

  6. Жернакова Ю.В., Чазова И.Е. Возможности нового блокатора рецепторов к ангиотензину в улучшении контроля артериальной гипертонии. Международное многоцентровое наблюдательное неинтервенционное проспективное исследование применения азилсартана медоксомила у пациентов с артериальной гипертонией и избыточной массой тела или ожирением в Российской Федерации и Республике Казахстан. Системные гипертензии. 2016; 13 (3): 6–12. doi: 10.26442/2075-082X_13.3.6-12.

  7. Multiple Risk Factor Intervention Trial Research Group. Mortality after 10 1/2 years for hypertensive participants in the multiple risk factor intervention trial. Circulation. 1990; 82(5): 1616–28. http://circ.ahaiournals.Org/content/82/5/1616

  8. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitors or calcium channel blocker vs diuretic. The Antihypertensive and LIPID-LOWERING TREATMENT TO PREVENT HEART ATTACK TRIAL (ALLHAT). JAMA. 2002; 288: 2981–97.

  9. Ernst M.E., Carter B.L., Goerdt C.J. et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. hypertension. 2006; 47: 352–58. https://www.ncbi.nlm.nih.gov/pubmed/16432050

  10. Musini V.M., Nazer M., Bassett K. et al. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev. 2014 May 29; (5): CD003824. doi: 10.1002/14651858.CD003824.pub2.

  11. Liebson P.R., Grandits G.A., Dianzumba S. et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation. 1995 Feb 1; 91(3): 698–706.

  12. Liebson P.R., Grandits G., Prineas R. et al. Echocardiographic correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS). Circulation. 1993 Feb; 87(2): 476–86.

  13. Кобалава Ж.Д., Виллевальде С.В., Кулаков В.В. Антигипертензивные эффекты фиксированной комбинации азилсартана медоксомил/хлорталидон у пациентов с неконтролируемой артериальной гипертонией. Кардиология. 2017; 57(11): 12–18. doi.org/10087/cardio.2017.11.10049.


About the Autors

Irina G. Khripunova, PhD, associate professor of the Department of therapy with a course of dietology of Stavropol State medical University of the Ministry of Healthcare of Russia. Address: 355017, Stavropol, 310 Mira Str. E-mail: igh2011@yandex.ru
Alesya A. Khripunova, PhD, associate professor of the Department of public health and Healthcare, medical prevention and informatics with postgraduate education course of Stavropol State medical University of the Ministry of Healthcare of Russia. Address: 355017, Stavropol, 310 Mira Str. E-mail: fktcz2007@yandex.ru
Olga I. Boeva, MD, associate professor, head of the imaging Department with postgraduate education course of Stavropol State medical University of the Ministry of Healthcare of Russia. Address: 355017, 310 Stavropol Mira Str. E-mail: box0271@mail.ru

Back to Content

Бионика Медиа