Naslov
Management of hypertension and new treatment options -Triapine

Autori
Zaputović, Luka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, pp prezentacija, znanstveni

Izvornik
5th Central European Meeting on Hypertension Final Programme and Abstract Book / Cifkova, Renata ; Jelaković, Bojan - Zagreb, 2009, 13-13

Skup
5th Central European Meeting on Hypertension

Mjesto i datum
Zagreb, Hrvatska, 22.10.2009. - 25.10.2009

Vrsta sudjelovanja
Plenarno

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
hypertension; management; ACE inhibitors; calcium channel blockers; fixed combination

Sažetak
Worldwide, hypertension is responsible for 62% of strokes and 49% of heart attacks. It is the third leading risk factor for disease and causes 7.1 million premature deaths each year. Hypertension represents a high burden on healthcare expenditure. Cardiovascular (CV) mortality risk doubles for each 20/10 mmHg increment in blood pressure (BP). Lower BP is associated with a decreased risk of CV events. Intensive BP lowering significantly reduces number of strokes in patients with coronary heart disease (CHD), and is associated with a lower rate of major CV events in hypertensive patients with diabetes. Prevalence of hypertension in Europe and North America remains high, between 40-50%. Awareness vs. treatment and control have not increased significantly and hypertension control in treated patients in western economies is still inadequate. Goals of therapy are established and recommended by the ESH/ESC 2007 guidelines, which advocate the use of combination therapy. Trials indicate that most patients require combination therapy to reach target BP. Initial use of two-drug fixed combination improves patients compliance, the percent of patients on BP goal, without doubling the number of adverse events observed with monotherapy. What is the rationale for the use of calcium channel blocker (CCB) and/or ACE inhibitor (ACE-I) in the hypertension management? Both classes are metabolically neutral, instead of diuretics and beta blockers having adverse metabolic effects on lipid profile, insulin sensitivity and glucose tolerance. In a meta-analysis including 94.492 hypertensives, beta-blockers increased the risk of new onset type 2 diabetes for 22%. ESH/ESC 2007 hypertension guidelines advocate the use of CCB (dihydropyridines) and ACE-I as the optimal antihypertensive drug in many specific conditions, with very few contraindications. ACE-Is protect against CHD and CCBs protect against stroke even beyond BP reduction, i.e. independently of antihypertensive activity. CCB and ACE-I combination reduce the risk of CV events to a greater extent than beta blocker and diuretic combination. The felodipine (dihydropyridine) and ramipril (ACE-I) is a new and atractive fixed combination in the treatment of hypertension. Previous studies have shown that felodipine significantly reduces the risk of major CV events. In the HOPE study ramipril 10 mg once daily also significantly reduced the risk of major CV outcomes, in all patients and especially in those with type 2 diabetes. Ramipril+felodipine combination reduces BP to a greater extent than monotherapy. More responders receiving ramipril+felodipine reduce BP <140/90 mmHg than either monotherapy. Ramipril+felodipine combination is well tolerated, peripheral oedema being less frequent than with felodipine monotherapy. In a dose ranging study the combination of ramipril and felodipine 5/5 mg reduced BP to a greater extent than monotherapy, was well tolerated and a better strategy than a dose increase of monotherapy. Despite the availability of effective antihypertensive drugs, many patients fail to meet their BP goals. Global CV risk and existing disorders of the individual patient has to be taken into account for the optimal choice of antihypertensive drugs. Combination therapy with an ACE-I and CCB effectively reduces BP. Both components have shown clinical benefits in large randomised clinical trials. Fixed-dose combination of ramipril and felodipine provide safe and effective treatment option for the management of hypertension, with a better patient's compliance.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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