G.D. Radchenko, L.O. Mushtenko, O.O. Torbas, S.M. Kushnir, O.A. Yarynkina, S.V. Potashev, Yu.M. Sirenko Influence of fixed dose combination perindopril/amlodipin on target organ damage in patients with and without ischemic heart disease (results of the EPHES study)

The aim – to compare efficacy of the fixed-dose combination (FDC) perindopril/amlodipine regarding decrease of blood pressure (BP) and dynamics of target organ damage patterns in patients with arterial hypertension (AH) with and without ischemic heart disease (IHD).

Materials and methods. The data received from 60 patients (aged > 30 years) with AH were analyzed: 1st group included 30 patients without IHD, 2nd group – 30 patients with IHD. At randomization day all patients were administered FDC perindopril/amlodipine in daily baseline dose 5/5 mg with up-titration to 10/10 mg every two weeks. If target BP was not achieved (> 140/90 mm Hg) after 6 weeks, indapamide 1.5 mg was added. The study protocol included body mass index measurements, office and ambulatory BP measurements, pulse wave velocity (PWV) and central SBP evaluation, augmentation index adjusted to heart rate 75 (AIx75) evaluation, biochemical analysis, ECG, EchoCG with Doppler, ankle-brachial index, intima-media thickness. The follow-up period was 12 months.

Results. Therapy based on FDC perindopril/amlodipine was effective in BP lowering (office, ambulatory, aorta) in both groups. Day- and night-time BP variability, morning surge of SBP and non-dipper rate have been decreased in both groups. In patients with IHD these parameters remained significantly higher than in patients without IHD at all stages of observation. During treatment we noted significant decrease of Aix75 in both groups, but Aix75 lowering was less in 2nd group compared to the 1st group, that was explained by more frequent using of beta-blockers in patients with IHD. Being effective in BP decrease, FDC provided significant diminishing of target organ damage – improving of PWVe and diastolic left ventricular function, decreasing of albuminuria, left ventricular hypertrophy and left atrium size. Adverse events were registered in 2 (6.5 %) patients of the 1st group and in 3 (10 %) of the 2nd group. There were no differences in patient complaints, but in group of IHD we noted significant decrease of angina episodes rate – from 2.5±0.4 till 1.2±0.2 (Р<0.01) per week. Conclusions. Treatment based on FDC perindopril/amlodipine was effective in BP decrease and in regression of target organ damage in both groups with and without IHD. Dynamics of target organ damage had some differences in groups, which should be taken into consideration during management of patients with and without IHD.

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