Pharmacoepidemiological Research of the Efficacy of Fixed Dose Combinations in the Treatment of Patients with Arterial Hypertension in Ambulatory Practice

Abstract

Aim. To study the pharmacoepidemiological features of the prescription of antihypertensive fixed dose combinations and their efficacy in hypertensive patients in the real outpatient practice in Vladivostok city.Material and methods. Hypertensive patients aged 1 8 years and older (n=268) observed in Vladivostok polyclinics from October to December 2017 were included into the study. All patients did not have target blood pressure (BP) levels. The analysis of the medical prescriptions of antihypertensive fixed dose combinations in Vladivostok polyclinics was performed. Two-component (perindopril + amlodipine) or three-component (perindopril + amlodipine + indapamide) fixed dose combinations were prescribed by physician in accordance with instructions for medical use and their pharmacological characteristics. The study was non-interventional and included 3 visits for the initial examination, prescription and correction of therapy, considering its efficacy. All patients were determined for glomerular filtration rate using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Formula), changes in BP. Patients performed self-esteem on a 1 0-point visual analogue scale (VAS).Results. Only 23.4% of patients reached target BP levels in the first month of observation, and 84.5% of patients after 3 months of observation. 30 (1 1.2%) patients had replacement with double antihypertensive fixed dose to triple combination combinations during the study. 68.6% of patients did not have a replacement for the initial prescribed antihypertensive fixed dose combinations due to the achievement of target BP. The number of patients with moderately and markedly reduced glomerular filtration rate was reduced significantly. Initially, the patients included into the study assessed health (according to adapted VAS) for 5.6±1.4 points, and after 3 months of follow-up - for 7.9±1.7 points.Conclusion. The use of antihypertensive fixed dose combinations containing ACE inhibitor (perindopril), calcium channel blocker (amlodipine) and thiazide-like diuretic (indapamide) resulted in achievement of target BP levels in 84.5% of patients after 3 months of follow-up. Also, the use of double and triple fixed dose combinations had a nephroprotective effect, manifested in an increase in the number of patients ( + 19.3%) with a glomerular filtration rate more than 60 ml/min/1,73м2 and a positive effect on the patient's well-being.

Keywords

• antihypertensive therapy
• fixed combination
• target blood pressure
• chronic kidney disease