Page 360 - Read Online

Page 2 of 9 Nedogoda et al. Vessel Plus 2018;2:37 I http://dx.doi.org/10.20517/2574-1209.2018.36

Conclusions: The fixed-dose combination of lisinopril + amlodipine + rosuvastatin provides improved BP control, better
vessel elasticity indicators (augmentation index, PWV, central BP), boosts the lipid and carbohydrate metabolism and
helps to reduce the inflammation and leptin resistance in patients who initially received a dual combination AHT.

Keywords: Arterial hypertension, pulse wave velocity, central blood pressure, augmentation index, leptin, inflammation,
combination antihypertensive therapy, lisinopril, amlodipine, rosuvastatin

INTRODUCTION
Analysis of trends in the development of the modern concept of reduction in cardiovascular risk and
mortality reveals several important directions.

[1]
[2]
First, there is a trend today to “tighten” the blood pressure (BP) and lipid targets, which should lead to
a further reduction in total and cardiovascular mortality in patients with arterial hypertension (AH) and
atherosclerosis. Second, the co-relation of the improved indicators of elasticity of different caliber vessels,
[3]
survival rate, and reduced risk of cardiovascular complications of AH can now be considered proven .
Principal differences have been found among the classes of antihypertensive drugs in the angioprotective
effect (influence on the augmentation index, central systolic and pulse pressure) and, ultimately, in the
[4,5]
influence on the typical end points (total and cardiovascular mortality, stroke, myocardial infarction) .
The same refers to individual representatives of antihypertensive classes [6-13] and various combinations of
antihypertensive drugs [14-16] . It has been shown that, upon achievement of the same BP level, lower mortality
[17]
occurs in the hypertensive patients with a decreased pulse wave velocity (PWV) . Third, low-intensity non-
infectious inflammation becomes an important and independent target of pharmacotherapy [18-20] , because
its reduction [first of all, in ultra-sensitive C-reactive protein (us-CRP)] allows not only to reduce the risk
[21]
of cardiovascular complications, but also to solve the problem of vascular comorbidity . Fourth, there is a
growing awareness that polypill is not only an opportunity to increase the patient’s medication adherence by
reducing the number of tablets taken, but also an effective multi-target pharmacotherapy option intended to
achieve the BP and lipid targets and hence maximally reduce the risk of cardiovascular complications.
[22]

In this respect, it would be practically important to assess the possibilities of a fixed-dose combination of
antihypertensive drugs with statins to provide a more pronounced angioprotection, to achieve the BP and
lipid targets and to suppress the inflammation in those hypertensive patients who previously underwent a
combination antihypertensive therapy (AHT).

The aim of this study was to assess the possibility of the fixed-dose combination of lisinopril + amlodipine +
rosuvastatin (Equamer, “Gedeon Richter”) to achieve further angioprotection in patients with AH and high
PWV despite the previous combination AHT.

METHODS
The purpose of the study was to assess changes in the indicators characterizing the elasticity of different
caliber vessels [PWV, wave reflection index (AI), central BP (CBP), intima-media thickness of the common
carotid artery, flow-dependent vasodilation], insulin resistance and inflammation after switching the patients
from the two-component antihypertensive combinations to the fixed-dose combination of lisinopril +
amlodipine + rosuvastatin. The target was considered to be BP < 140/90 mmHg.

The open-label study included patients who met all of the following criteria: age from 18 to 65 years, previous
combined AHT conducted for at least 6 months, PWV above 10 m/s, age-standardized; signed informed
consent of the patient to participate in the study.