Korean Circ J.  2008 May;38(5):237-243. 10.4070/kcj.2008.38.5.237.

Recent Update on Fixed Combinations of Antihypertensive Agents

• Park CG

• KMID: 2225784
• DOI: http://doi.org/10.4070/kcj.2008.38.5.237

Abstract

The amlodipine/atorvastatin single tablet has been shown to improve patients' achievement of national guideline recommended blood pressure and lipid target levels and exhibits a safety profile consistent with the parent com-pounds. The single tablet formulation has the potential to improve adherence and decrease prescription costs. These potential benefits are associated with important implications because hypertensive patients with additional risk factors represent a large proportion of those at risk for cardiovascular events. Combination low-dose drug treatment increases efficacy and reduces adverse effects. Fixed low-dose combination drug treatment increases efficacy and reduces adverse effects. This combination has greater potency and a similar side effect profile to monotherapy and represents a highly effective approach for attaining goal blood pressure levels using a therapeutic strategy that very effectively lowers blood pressure, is well-tolerated, and minimizes increasing doses of monotherapy-induced metabolic effects.

Keyword

Combination drug therapy; Amlodipine; Atorvastatin; Risk reduction

MeSH Terms

Achievement
Amlodipine
Antihypertensive Agents
Blood Pressure
Drug Therapy, Combination
Heptanoic Acids
Humans
Parents
Prescriptions
Pyrroles
Risk Factors
Risk Reduction Behavior
Atorvastatin Calcium
Amlodipine
Antihypertensive Agents
Heptanoic Acids
Pyrroles

Figure

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  Fig. 1 Efficacy of amlodipine/atorvastatin compared with single-agent therapy or placebo in patients with concomitant hypertension and dyslipidemia. *p=.225 versus atorvastatin; p<.001 versus amlodlpine, †p<.001 versus atorvastatin; p=.520 versus amlodipine, ‡p<.001 versus atorvastatin; p<.001 versus amlodlpine. NCEP ATP III: national cholesterol education program adult treatment panel guideline III, JNC: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

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  Fig. 2 Tolerability of amlodipine/atorvastatin compared with single-agent therapy or placebo. The graph shows adverse events in patients with co-existing hypertension and dyslipidemia who were randomized to once-daily amlodipine plus atorvastatin (any of eight dose combinations; n=885), amlodipine (5 or 10 mg alone; n=221), atorvastatin (10, 20, 40, or 80 mg alone; n=443), or placebo (n=111) in the double-blind, double-dummy, multicenter RESPOND trial.

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  Fig. 3 Two-to-four antihypertensive agents are required to achieve effective BP control to target levels. BP: blood pressure, DBP: diastolic blood pressure, MAP: mean arterial pressure, SBP: systolic blood pressure.

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  Fig. 4 Comparison of the antihypertensive effects of irbesartan/HCTZ (150/12.5 mg) and valsartan/HCTZ (80/12.5 mg) in hypertensive patients in the COmparative Study of Efficacy of Irbesartan/HCTZ with Valsartan/HCTZ Using Home Blood Pressure Monitoring in the TreAtment of Mild-to-Moderate Hypertension (COSIMA) study.22) *p=0.0317, †p=0.0002, ‡p=0.0005, §p<0.0001. Error bars represent 95% Confidence Intervals. n: number controlled, HCTZ: hydrochlorothiazide.

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  Fig. 5 Rates of (A) total AEs, (B) total discontinuations, and (C) total discontinuations as a result of AEs in the groups that received valsartan (160 mg) plus hydrochlorothiazide (12.5 mg [V+HCTZ12.5]), valsartan (160 mg) plus HCTZ (25 mg [V+HCTZ 2S]), and amlodipine (10 mg [A10]). *p<0.05 vs. combination-therapy groups. HCTZ: hydrochlorothiazide.

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