2018 AND 2019 GUIDELINES FOR THE MANAGEMENT OF ARTERIAL HYPERTENSION: IS THERE A PLACE FOR UNFIXED DRUG COMBINATIONS?

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Abstract

The end of 2018 and the beginning of 2019 were marked by 2 important events in medicine, namely the release of new European and Russian guidelines for the management of arterial hypertension. For most patients, fixed combinations of antihypertensive drugs are recommended as first step treatment. Today, in the Russian Federation, despite the variety of fixed drug combinations there are combinations that are effective, meet the latest recommendations, but are not currently presented in fixed form, for example, a combination of indapamide and angiotensin II receptor blocker. Indapamide not only effectively reduces blood pressure, but also has a number of organoprotective effects (cerebro-, cardio- and nephroprotective). The data of PROGRESS (Perindopril protection against Recurrent Stroke Study) and PATS (Post-stroke Antihypertensive Treatment Study) studies on indapamide provided the basis of American recommendations for the secondary prevention of stroke, and HYVET-COG (Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment) study showed a decrease in the risk for dementia in patients treated with indapamide. These data, along with the results of other placebo-controlled studies, were included in the meta-analysis mentioned above, a statistically significant decrease in a risk of dementia was noted in the “antihypertensive treatment” group compared to placebo. Angiotensin II receptor blockers also have marked organoprotective effect and a large evidence base on their ability to reduce the risk for coronary and cerebrovascular (stroke, dementia) complications. One more effective unfixed drug combination that is not registered on the market is a combination of nitrendipine and indapamide, which can be effectively used not only to lower blood pressure, but also to prevent dementia, including in Alzheimer's disease. Thus, although the new European and Russian guidelines give preference to fixed combinations of antihypertensive drugs, there are clinical situations where it seems appropriate to consider prescribing unfixed combinations of antihypertensive drugs.

About the authors

Anton P. Pereverzev

Pirogov Russian National Research Medical University

Email: acchirurg@mail.ru
канд. мед. наук науч. сотр. лаб. клинической фармакологии и фармакотерапии

Olga D. Ostroumova

Pirogov Russian National Research Medical University; Russian Medical Academy of Continuous Professional Education

д-р мед. наук, проф., зав. лаб. клинической фармакологии и фармакотерапии

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