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Nedogoda et al. Vessel Plus 2018;2:37 I http://dx.doi.org/10.20517/2574-1209.2018.36 Page 7 of 9

AHT is confirmed by the initiation of The LOW CBP study (Targeted LOWering of CBP in patients with
hypertension: a randomised controlled trial) and the findings that the combinations of perindopril +
amlodipine, valsartan + amlodipine, azelnidipine + olmesartan have a more pronounced positive effect
on aortic elasticity than the combinations of atenolol + hydrochlorothiazide, atenolol + amlodipine,
olmesartan + hydrochlorothiazide [12-13] . We must also add the trend to a “tighter” control of BP, lipids
and inflammation [1,2,18-21] . Therefore, it is appropriate to try to solve these problems using the fixed-dose
combination of lisinopril + amlodipine + rosuvastatin which is also able to perform the task of a multi-
target pharmacotherapy.

First of all, it should be noted that switching patients from different two-component antihypertensive
combinations (mainly the renin-angiotensin-aldosterone system blockers and diuretics) therapy which they
underwent for at least 6 months to the fixed-dose combination of lisinopril + amlodipine + rosuvastatin
has provided the achievement of the target BP in 7 out of 10 patients, given the fact that the study did
not involve the use of maximum doses of antihypertensive drugs in this combination. This is apparently
[26]
explained by an enhancement of the hypotensive potential due to the statins . The decrease in BP has been
confirmed by the data of the 24 h BP monitoring, and all the groups of the initial therapy have shown a
positive effect of the fixed-dose combination of lisinopril + amlodipine + rosuvastatin on the BP variability,
which can be considered as an important component in the correction of systemic hemodynamic
[27]
atherothrombotic syndrome .
The improved control of BP after the use of the fixed-dose combination of lisinopril + amlodipine +
rosuvastatin and the lipid target achievement in 7 out of 10 patients has been naturally accompanied by
positive changes in the indicators of vessel wall elasticity (PWV, CBP, AI, vascular age). These favorable
changes should be explained not only by the achievement of the BP and lipid targets, but also the positive
effect on adipokines (leptin and adiponectin) and low-intensity non-infectious inflammation (us-CRP),
which represents an additional factor of angioprotection [28-30] .

It is important to emphasize that the use of rosuvastatin in combination with lisinopril and amlodipine
has been accompanied by a decrease in the insulin resistance and a positive effect on the carbohydrate
metabolism, which removes all the questions about the diabetogenic potential of statins when used in this
therapy option.

Thus, it can be said that switching patients from two-component antihypertensive combinations to the
fixed-dose combination of lisinopril + amlodipine + rosuvastatin provides better control of BP, lipids,
angioprotection and reduction of inflammation in combination with improved carbohydrate metabolism
and balance of adipokines.

DECLARATIONS
Authors’ contributions
Conceived of the study: Nedogoda SV
Recruitment and clinical assessment, statistical analysis: Chumachek EV, Ledyaeva AA, Tsoma VV, Salasyuk
AS, Smirnova VO, Hripaeva VY, Palashkin RV, Popova EA
Drafted the initial version of the report: Chumachek EV, Salasyuk AS
Revision and editing of the report: all authors

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