Triple drug combinations in cardiology

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Abstract

At present cardiac medications occupy an important place among polypills. According to European Society of Hypertension and European Society of Cardiology 2013 guidelines on hypertension treatment either free or fixed (preferable) combinations of two, three or more antihypertensive drugs are applicable at present. It should be noted that fixed combination has some advantages compared to a free one, especially in patients' compliance, that in its turn will contribute to cardiovascular risk reduction. It allows to reach target blood pressure (BP) level, has simple administration, dose titration and dosage regimen, and eliminates the risk of irrational combinations use. Also counter-regulatory mechanisms blockade is quite important: when fixed combination of drugs of different groups is used these medications can compensate adverse effects of each other, for example reduce edema that develops secondary when calcium channel blocking agents are used. Dosage regimen and titration are key stages in clinical practice. Fixed combination amlodipine + indapamide + perindopril has the greatest "flexibility" among triple fixed combinations. Advances of triple combination amlodipine + indapamide + perindopril use were studied in many randomized controlled trials. ADVANCE trial demonstrated effectiveness of triple fixed combinations use in all-cause mortality decrease of 14%, as well as cardiovascular mortality decrease of 28% compared with 5% in patients who received double therapy (р=0.02). PIANIST study showed high treatment compliance and effective BP reduction: target BP was reached in 72% of patients. Therefore, a lot of various polypills exist at present that allows clinicians to increase therapy effectiveness with the use of rational drug combinations and patients' compliance increase.

About the authors

A. G Arutiunov

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: agarutyunov@mail.ru
д-р мед. наук, проф. каф. пропедевтики внутренних болезней, общей физиотерапии и лучевой диагностики педиатрического фак-та 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

D. O Dragunov

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; Research Institute of Health Organization and Medical Management of the Department of Health of Moscow

канд. мед. наук, доц. каф. пропедевтики внутренних болезней, общей физиотерапии и лучевой диагностики педиатрического фак-та, зав. организационно-методическим отд. по терапии 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

A. V Sokolova

N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

канд. мед. наук, ассистент каф. пропедевтики внутренних болезней, общей физиотерапии и лучевой диагностики педиатрического фак-та, вед. специалист организационно-методического отд. по терапии 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

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