Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Advances in Therapy
Erschienen in: Advances in Therapy 10/2018

20.08.2018 | Original Research

Combination Antihypertensive Therapy with Perindopril and Indapamide in Patients with Essential Hypertension: Effect on Endothelial and Cognitive Markers of Vascular Improvement

verfasst von: Elena A. Zheleznykh, Yulia A. Danilogorskaya, Elena V. Privalova, Yury N. Belenkov, Anastasia A. Schendrygina, Irina S. Chekneva, Nikolay A. Pavlov, Mikhail I. Tishman

Erschienen in: Advances in Therapy | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

The objective of this study was to assess the impact of a single-pill combination (SPC) of perindopril/indapamide (PER/IND) at full doses (10/2.5 mg) on endothelial and cognitive function as a clinical intermediate marker of vascular improvement.

Methods

This open-label, uncontrolled, observational study enrolled 30 patients (20 females and 10 males) with grade II–III uncontrolled arterial hypertension (SBP/DBP ≥ 160/100 mmHg) and no evidence of cerebrovascular disease. All patients underwent assessment of macro- and microvascular endothelial function parameters at baseline and after 12 months of treatment with SPC PER/IND using photoplethysmography and video capillaroscopy. Cognitive function was assessed using the Montreal Cognitive Assessment scale (MoCA).

Results

All patients (mean age 60.06 ± 10.19 years) were at high risk for cardiovascular events: mean body mass index (BMI) 31.2 ± 3.9 kg/m2, 33% diagnosed with coronary artery disease angina class I, 30% with impaired glucose tolerance, and 7% with type 2 diabetes. Impaired endothelial function was observed at the both micro- and macrovascular levels. Endothelial function parameters improved after 12-month treatment with SPC PER/IND with an increase in occlusion index from 1.4 to 1.8 (P < 0.00005) and phase shift from 5.0 to 10.8 (P < 0.00001); all values achieved levels in the normal range. Resting capillary network density (CND) increased from 44.8 to 52 cap/mm2 (P < 0.00007), and CND after a venous occlusion test increased from 55 to 61 cap/mm2 (P < 0.006). Signs of cognitive impairment were present at baseline with a mean MoCA score of 23 (normal cognitive function score ≥ 26), but improved after 12-month treatment with a mean MoCA score of 27 (P< 0.0001). Treatment was well tolerated.

Conclusion

SPC PER/IND at full doses for 12 months improves endothelial function, structural and functional parameters of the microcirculation, as well as cognitive function in patients with arterial hypertension at high cardiovascular risk.

Funding

Les Laboratoires Servier.
Literatur
1.
Xu Y, Arora RC, Hiebert BM, Lerner B, Szwajcer A, McDonald K, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2014;15(7):736–46.CrossRefPubMed
2.
Shechter M, Shechter A, Koren-Morag N, Feinberg MS, Hiersch L. Usefulness of brachial artery flow-mediated dilation to predict long-term cardiovascular events in subjects without heart disease. Am J Cardiol. 2014;113(1):162–7.CrossRefPubMed
3.
Hassan A, Hunt BJ, O’Sullivan M, Parmar K, Bamford JM, Briley D, et al. Markers of endothelial dysfunction in lacunar infarction and ischaemic leukoaraiosis. Brain. 2003;126(Pt 2):424–32.CrossRefPubMed
4.
Consoli D, Di Carlo A, Inzitari D, De Lucia D, Lamassa M, D’Avino M, et al. Subcortical ischaemic changes in young hypertensive patients: frequency, effect on cognitive performance and relationship with markers of endothelial and haemostatic activation. Eur J Neurol. 2007;14(11):1222–9.CrossRefPubMed
5.
Targonski PV, Bonetti PO, Pumper GM, Higano ST, Holmes DR Jr, Lerman A. Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events. Circulation. 2003;107(22):2805–9.CrossRefPubMed
6.
Modena MG, Bonetti L, Coppi F, Bursi F, Rossi R. Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol. 2002;40:505–10.CrossRefPubMed
7.
Kitta Y, Obata JE, Nakamura T, Hirano M, Kodama Y, Fujioka D, et al. Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease. J Am Coll Cardiol. 2009;53:323–30.CrossRefPubMed
8.
Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, The ADVANCE Collaborative Group, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007;370(9590):829–40.CrossRefPubMed
9.
Cleland JG, Tendeцra M, Adamus J, Freemantle N, Polonski L, Taylor J, PEP-CHF Investigators. The perindopril in elderly people with chronic heart failure (PEP-CHF). Eur Heart J. 2006;27:2338–45.CrossRefPubMed
10.
Dahlof B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, ASCOT Investigators, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906.CrossRefPubMed
11.
Fox KM, EUROPA investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362:782–8.CrossRefPubMed
12.
Ferrari R, PREAMI investigators. Effects of ACE inhibition with perindopril on left ventricular remodeling and clinical outcome. Arch Intern Med. 2006;166:659–66.CrossRefPubMed
13.
Chalmers J, MacMahon S, Anderson C, The PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033–41.CrossRef
14.
Mogensen CE, Viberti G, Halimi S, Ritz E, Ruilope L, Jermendy G, et al. Effect of low-dose perindopril/indapamide on albuminuria in diabetes: preterax in albuminuria regression: pREMIER. Hypertension. 2003;41:1063–71.CrossRefPubMed
15.
Mourad JJ, Waeber B, Zannad F, Laville M, Duru G, Andréjak M. Comparison of different therapeutic strategies in hypertension: a low-dose combination of perindopril/indapamide versus a sequential monotherapy or a stepped-care approach. J Hypertens. 2004;22:2379–86.CrossRefPubMed
16.
Mallion JM, Chamontin B, Asmar R, De Leeuw PW, et al. Twenty-four-hour ambulatory blood pressure monitoring efficacy of perindopril/indapamide first-line combination in hypertensive patients: the REASON study. Am J Hypertens. 2004;17:245–51.CrossRefPubMed
17.
Castaigne A, Chalmers J, Morgan T, Chastang C, Feldmann L, Guez D. Efficacy and safety of an oral fixed low-dose perindopril 2 mg/indapamide 0.625 mg combination: a randomized, double-blind, placebo-controlled study in elderly patients with mild to moderate hypertension. Clin Exp Hypertens. 1999;21:1097–110.CrossRefPubMed
18.
Chalmers J, Castaigne A, Morgan T, Chastang C. Long-term efficacy of a new, fixed, very-low-dose angiotensin-converting enzyme-inhibitor/diuretic combination as first-line therapy in elderly hypertensive patients. J Hypertens. 2000;18:327–37.CrossRefPubMed
19.
Asmar RG, London GM, O’Rourke ME, Safar ME. Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol. Hypertension. 2001;38:922–6.CrossRefPubMed
20.
Perkovic V, Joshi R, Patel A, Bompoint S, Chalmers J, ADVANCE Collaborative Group. ADVANCE: lessons from the run-in phase of a large study in type 2 diabetes. Blood Press. 2006;15(6):340–6.CrossRefPubMed
21.
Joannides R, Bellien J, Thurlure C, Iacob M, Abeel M, Thuillez C. Fixed combination of perindopril and indapamide at low dose improves endothelial function in essential hypertensive patients after acute administration. Am J Hypertens. 2008;21(6):679–84.CrossRefPubMed
22.
Debbabi H, Bonnin P, Levy BI. Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients. Am J Hypertens. 2010;23(10):1136–43.CrossRefPubMed
23.
Ghiadoni L, Magagna A, Kardasz I, Taddei S, Salvetti A. Fixed dose combination of perindopril and indapamide improves peripheral vascular function in essential hypertensive patients. Am J Hypertens. 2009;22(5):506–12.CrossRefPubMed
24.
Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Task Force Members, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357.CrossRef
25.
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Authors/Task Force Members, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.CrossRefPubMedPubMedCentral
26.
Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Kajiyama G, Oshima T. A noninvasive measurement of reactive hyperemia that can be used to assess resistance artery endothelial function in humans. Am J Cardiol. 2001;87:121–5.CrossRefPubMed
27.
Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107:2864–9.CrossRefPubMed
28.
DeLano FA, Schmid-Schönbein GW, Skalak TC, Zweifach BW. Penetration of the systemic blood pressure into the microvasculature of rat skeletal muscle. Microvasc Res. 1991;41(1):92–110.CrossRefPubMed
29.
Ghiadoni L, Magagna A, Versari D, Kardasz I, Huang Y, Taddei S, et al. Different effect of antihypertensive drugs on conduit artery endothelial function. Hypertension. 2003;41:1281–6.CrossRefPubMed
30.
Vinereanu D, Dulgheru R, Magda S, Dragoi Galrinho R, Florescu M, Cinteza M, et al. The effect of indapamide versus hydrochlorothiazide on ventricular and arterial function in patients with hypertension and diabetes: results of a randomized trial. Am Heart J. 2014;168(4):446–56.CrossRefPubMed
31.
Bataillard A, Schiavi P, Sassard J. Pharmacological properties of indapamide. Rationale for use in hypertension. Clin Pharmacokinet. 1999;37:7–12.CrossRefPubMed
32.
NICE—Clinical Guidelines Hypertension: The clinical management of primary hypertension in adults—NCGC (National Clinical Guideline Centre) 127, August 2011.
33.
Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, for Hypertension Canada. Hypertension Canada’s 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Can J Cardiol. 2017;33(5):557–76.CrossRefPubMed
34.
Dahlöf B, Gosse P, Guéret P, Dubourg O, de Simone G, Schmieder R, et al. PICXEL Investigators. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J Hypertens. 2005;23(11):2063–70.CrossRefPubMed
35.
de Luca N, Mallion JM, O’Rourke MF, O’Brien E, Rahn KH, Trimarco B, et al. Regression of left ventricular mass in hypertensive patients treated with perindopril/indapamide as a first-line combination: the REASON echocardiography study. Am J Hypertens. 2004;17:660–7.PubMed
36.
Farsang C. Efficacy and tolerability of fixed-dose combination of perindopril/indapamide in type 2 diabetes mellitus: PICASSO trial. Adv Ther. 2014;31(3):333–44.CrossRefPubMedPubMedCentral
37.
Karpov YA; FORTISSIMO physicians. Full-dose perindopril/indapamide in the treatment of difficult-to-control hypertension: the FORTISSIMO Study. Clin Drug Investig. 2017;37(2):207–17.CrossRef
38.
Kilander L, Nyman H, Boberg M, Hansson L, Lithell H. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension. 1998;31(3):780–6.CrossRefPubMed
39.
Tzourio C, Nilsson P, Scuteri A, Laurent S. Subclinical brain damage and hypertension. Eur Soc Hypertens Scientific Newsletter: Update on Hypertension Management. 2010;11: No.45.
40.
Dufouil C, Godin O, Chalmers J, Coskun O, MacMahon S, Tzourio-Mazoyer N, PROGRESS MRI Substudy Investigators. Severe cerebral white matter hyperintensities predict severe cognitive decline in patients with cerebrovascular disease history. Stroke. 2009;40(6):2219–21.CrossRefPubMed
41.
Dufouil C, Chalmers J, Coskun O, Besançon V, Bousser MG, Guillon P, PROGRESS MRI Substudy Investigators. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy. Circulation. 2005;112(11):1644–50.CrossRefPubMed
42.
Peters R, Beckett N, Forette F, Tuomilehto J, Clarke R, Ritchie C, et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7(8):683–9.CrossRefPubMed
43.
Triantafyllidi H, Arvaniti C, Lekakis J, Ikonomidis I, Siafakas N, Tzortzis S, et al. Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension. Am J Hypertens. 2009;22(5):525–30.CrossRefPubMed
44.
Webb AJ, Pendlebury ST, Li L, Simoni M, Lovett N, Mehta Z, et al. Validation of the MoCA versus MMSE against hypertension and hypertensive arteriopathy after TIA or minor stroke. Stroke. 2014;45(11):3337–42.CrossRefPubMedPubMedCentral
45.
Tzourio C, Anderson C, Chapman N, Woodward M, Neal B, MacMahon S, PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;163(9):1069–75.CrossRefPubMed
46.
Sink KM, Leng X, Williamson J, Kritchevsky SB, Yaffe K, Kuller L, et al. Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: results from the Cardiovascular Health Study. Arch Intern Med. 2009;169(13):1195–202.CrossRefPubMedPubMedCentral
47.
Gao Y, O’Caoimh R, Healy L, Kerins DM, Eustace J, Guyatt G, et al. Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia. BMJ Open. 2013;3(7):e002881.CrossRefPubMedPubMedCentral
48.
O’Caoimh R, Kehoe PG, Molloy DW. Renin angiotensin aldosterone system inhibition in controlling dementia-related cognitive decline. J Alzheimer’s Dis. 2014;42(Suppl 4):S575–86.CrossRef
49.
Zhuang S, Wang HF, Li J, Wang HY, Wang X, Xing CM. Renin-angiotensin system blockade use and risks of cognitive decline and dementia: a meta-analysis. Neurosci Lett. 2016;624:53–61.CrossRefPubMed
Metadaten
Titel
Combination Antihypertensive Therapy with Perindopril and Indapamide in Patients with Essential Hypertension: Effect on Endothelial and Cognitive Markers of Vascular Improvement
verfasst von
Elena A. Zheleznykh
Yulia A. Danilogorskaya
Elena V. Privalova
Yury N. Belenkov
Anastasia A. Schendrygina
Irina S. Chekneva
Nikolay A. Pavlov
Mikhail I. Tishman
Publikationsdatum
20.08.2018
Verlag
Springer Healthcare
Erschienen in
Advances in Therapy / Ausgabe 10/2018
Print ISSN: 0741-238X
Elektronische ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-018-0773-2

Weitere Artikel der Ausgabe 10/2018

Advances in Therapy 10/2018 Zur Ausgabe

Review

Diagnosis and Management of Hypothyroidism: Addressing the Knowledge–Action Gaps

Review

Efficacy of Monotherapy with Biologics and JAK Inhibitors for the Treatment of Rheumatoid Arthritis: A Systematic Review

Review

An Update of Efficacy and Safety of Cetuximab in Metastatic Colorectal Cancer: A Narrative Review

Original Research

72-Week Safety and Tolerability of Dimethyl Fumarate in Japanese Patients with Relapsing-remitting Multiple Sclerosis: Analysis of the Randomised, Double Blind, Placebo-Controlled, Phase III APEX Study and its Open-Label Extension

Commentary

Does ‘Strong Analgesic’ Equal ‘Strong Opioid’? Tapentadol and the Concept of ‘µ-Load’

Commentary

A Charter to Improve Patient Care in Severe Asthma

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

25.04.2024 | Hypotonie | Nachrichten

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 | Hypertonie | Nachrichten

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 | Nierenkarzinom | Nachrichten

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 | NSCLC | Nachrichten

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC
weitere anzeigen

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise