Assessment of Efficacy of Combined Pharmacotherapy With Fixed Perindopril/Amlodipine Combination in Patients With Combined Cardiovascular Pathology in Outpatient Practice

Aim: to study effects of using fixed perindopril/amlodipine combination in complex treatment of patients with combined cardiac pathology in active observation mode, in comparison with other angiotensin converting enzyme (ACE inhibitors) or angiotensin II receptor antagonists (ARA), including free combination with calcium channel blockers (CCB) in conditions of routine outpatient practice. Materials and methods. The design of the study included two stages: I - monitoring effectiveness of pharmacotherapy performed in routine outpatient practice (duration of 2 months), II - “active treatment (management)” - changing the pharmacotherapy scheme in patients who did not reach the target level of “office” blood pressure (BP), monitoring patients for 6 months and carrying out, if necessary, dose correction of the newly appointed treatment regimen. The study included 50 patients aged 45-65 years with combined cardiovascular pathology: II-III degree arterial hypertension, I-III functional class (FC) stable angina pectoris, I-III FC chronic cardiac failure. Results. Number of patients who reached target level of office BP by the end of active observation was 41 (p<0.001 in comparison with routine therapy). During 6-month treatment episodes of ischemic ST-segment depression were eliminated in 37 patients (there were no such patients during routine therapy, p<0.001). At the end of the period of routine pharmacotherapy, 1 and 5 patients had a reduction (more than by 80% from the baseline level) of the number of ventricular and supraventricular extrasystoles, respectively. During 6-month active treatment extrasystoles were additionally eliminated in 14 (p<0.001) and 18 (p<0.010) patients, respectively. During the period of active treatment there occurred significant improvement of parameters of role-physical functioning, vitality, mental health (p<0.05) compared with preceding period of 2 months of routine management. During routine pharmacotherapy, depression and anxiety were eliminated in 14 and 13 patients, respectively. During further active treatment parameters of depression and anxiety were normalized in 23 and 20 patients, respectively (p<0.05 for anxiety and p<0.01 for depression vs. preceding period of treatment in routine conditions). Conclusion. Replacement of free combinations of ACE inhibitors or ARA and CCB with fixed perindopril/ amlodipine combination in the complex pharmacotherapy of patients with combined cardiac pathology, together with adjustment of the entire management regimen in accordance with current clinical recommendations and the use of active observation of patients in comparison with preceding routine outpatient treatment was associated with significant positive effects on daily BP profile, ECG signs of myocardial ischemia and arrhythmic activity, parameters of quality of life, and levels of anxiety and depression

артериальная гипертония, стабильная стенокардия напряжения, хроническая сердечная недостаточность, фармакотерапия, arterial hypertension, stable angina pectoris, chronic heart failure, pharmacotherapy

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