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Leggio M, Fusco A, Loreti C, Limongelli G, Bendini MG, Mazza A, Frizziero A, Coraci D, Padua L. Fixed and Low-Dose Combinations of Blood Pressure-Lowering Agents: For the Many or the Few? Drugs 2020; 79:1831-1837. [PMID: 31602564 DOI: 10.1007/s40265-019-01209-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the widespread availability of several effective classes of drugs, systemic arterial hypertension remains poorly controlled in the majority of patients worldwide. In this article, we discuss the different modalities and effects of combination therapy and possible future research questions. Treatment with a single antihypertensive agent can effectively reduce blood pressure in only a limited number of patients, while most require therapy with two or more agents to achieve target levels. As initial therapy, American and European guidelines suggest a combination of two antihypertensive drugs and the use of a third antihypertensive drug when hypertension is still uncontrolled. Initial combination therapy is recommended in high-risk patients for an immediate blood pressure response, improved tolerability and possibly increased patient adherence. In addition to the potential benefits of combining different drug classes with synergistic pharmacological and physiological actions, this approach is useful for increasing the patient compliance with treatment, in particular if provided at fixed doses in a single pill. The minimisation of side effects is critical for the long-term treatment of a largely asymptomatic condition such as systemic hypertension. Low-dose combinations of different drugs from classes with complementary actions may provide the best ratio of lower side effects and improved tolerability with a significant blood pressure reduction, particularly in high-risk patients. This approach could be aided by a multidisciplinary lifestyle intervention on risk factors.
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Affiliation(s)
- Massimo Leggio
- Cardiology Operative Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Augusto Fusco
- IRCCS Fondazione Don Carlo Gnocchi, P.le Rodolfo Morandi, 6, 20121, Milan, Italy.
| | - Claudia Loreti
- IRCCS Fondazione Don Carlo Gnocchi, P.le Rodolfo Morandi, 6, 20121, Milan, Italy
| | | | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padua, Italy
| | - Daniele Coraci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Padua
- Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Omboni S, Volpe M. Management of arterial hypertension with angiotensin receptor blockers: Current evidence and the role of olmesartan. Cardiovasc Ther 2018; 36:e12471. [PMID: 30358114 PMCID: PMC6587798 DOI: 10.1111/1755-5922.12471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/28/2022] Open
Abstract
Elevated blood pressure (BP) is a major determinant of morbidity and mortality burden related to cardio‐metabolic risk. Current guidelines indicate that controlling and lowering BP promotes cardiovascular (CV) risk reduction. Among antihypertensive agents, angiotensin receptor blockers (ARBs) are characterized by an efficacy profile equivalent to other antihypertensive agents and are provided with excellent tolerability and low discontinuation rates during chronic treatments. Moreover, CV outcomes are reduced by ARBs. Olmesartan is a long‐lasting ARB which proved to achieve a comparable or more effective action in lowering BP when compared to other ARBs. Olmesartan, in fact, displayed a larger and more sustained antihypertensive effect over the 24 hours, with a buffering effect on short‐term BP variability. These are important features which differentiate olmesartan from the other principles of the same class and that may help to control the increased CV risk in the presence of high BP variability. Olmesartan shows similar benefits as other ARBs in terms of all‐cause and CV mortality, and a favorable tolerability profile. Combination of olmesartan with long‐lasting calcium‐channel blockers and thiazide diuretics represents a rational and effective therapy. Thus, ARBs, including olmesartan, represent one of the most effective and safe treatments for patients with arterial hypertension.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Massimo Volpe
- Chair and Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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Olmesartan medoxomil/amlodipine/hydrochlorothiazide 20 mg/5 mg/12.5 mg fixed-dose combination in hypertension: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-017-0465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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