Combined use of azilsartan and amlodipine in patients with arterial hypertension and high cardiovascular risk

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Abstract

Arterial hypertension is a leading modifiable risk factor of cardiovascular diseases. To increase life expectancy in patients with arterial hypertension, adequate blood pressure (BP) control is necessary to reduce the risk of cardiovascular complications. As an initial therapy, most patients are recommended to use a combination of antihypertensive drugs, preferably it should be a fixed combination, to improve adherence to therapy. The most frequently prescribed combination antihypertensive therapy is a combination of long-acting dihydropyridine calcium antagonists and angiotensin II receptor blockers. New combination of azilsartan medoxomil and amlodipine is characterized by a synergistic mechanism of antihypertensive action, complementary pharmacokinetics, it can provide 24-hour blood pressure control and reduce its daily variability, and also helps achieve target blood pressure with the highest probability in comparison with combinations of other sartans with amlodipine.

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Veronika V. Tolkacheva

RUDN University

Author for correspondence.
Email: Tolkacheva_vv@pfur.ru
ORCID iD: 0000-0001-6847-8797
SPIN-code: 2282-2127
Scopus Author ID: 8307379200

MD, Dr. Sci. (Medicine), professor, professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of the Medical Institute

Russian Federation, 117198, Moscow, 6 Miklukho-Maklaya St.

Zhanna D. Kobalava

RUDN University

Email: zkobalava@mail.ru
ORCID iD: 0000-0002-5873-1768
SPIN-code: 9828-5409
Scopus Author ID: 7004399203

MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academicianV.S. Moiseyev of the Institute of clinical medicine of the Medical Institute

Russian Federation, 117198, Moscow, 6 Miklukho-Maklaya St.

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2. Fig. 1. Scheme of the Edarbi® Am calendar blister

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3. Fig. 2. Mechanism of action of azilsartan and amlodipine in arterial hypertension*

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4. Fig. 3. Schematic representation of the pharmacokinetics following a single dose of azilsartan 40 mg and amlodipine 5 mg in healthy volunteers* Note: * - adapted from [15-19].

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5. Fig. 4. Dynamics of clinical blood pressure during 6-week therapy with azilsartan + amlodipine* Note: * - adapted from [120]; * - p < 0.001 compared to the placebo + amlodipine 5 mg group. BP - blood pressure; SBP - systolic blood pressure; DBP - diastolic blood pressure.

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6. Fig. 5. Daily systolic blood pressure profile at week 6 of azilsartan + amlodipine* therapy Note: * - adapted from [20]: * - P < 0.001 compared to the placebo + amlodipine 5 mg group. SBP - systolic blood pressure.

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7. Fig. 6. Frequency of achieving target blood pressure with azilsartan + amlodipine compared with placebo + amlodipine* Note: * - adapted from [20]; * - p < 0.001 compared with the placebo + amlodipine 5 mg group. SBP - systolic blood pressure; DBP - diastolic blood pressure.

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8. Fig. 7. Changes in clinical systolic blood pressure by week 8 of treatment with the azilsartan + amlodipine combination compared to monotherapy with these drugs* Note: * - adapted from [21]; p < 0.0001 for all comparison groups. SBP - systolic blood pressure.

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9. Fig. 8. Network meta-analysis: differences in the efficacy of combining various angiotensin II receptor blockers with amlodipine in reducing systolic blood pressure compared to amlodipine alone (control - 5 or 10 mg)* Note: * - adapted from [24]; # - p < 0.0001 compared with the amlodipine group; ## - p = 0.0011 compared with the amlodipine group; ### - p = 0.0003 compared with the amlodipine group. SBP - systolic blood pressure; RCTs - randomized controlled trials.

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