ФИКСИРОВАННАЯ КОМБИНАЦИЯ ИРБЕСАРТАН/ГИДРОХЛОРТИАЗИД В ЛЕЧЕНИИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ

И.Н. Кожанова

Белорусский государственный медицинский университет

В Республике Беларусь почти треть населения имеет повышенный уровень артериального давления, и соответственно подвергаются высокому риску развития сердечно-сосудистых заболеваний. Несмотря на доступность антигипертензивных препаратов, более 40% пациентов, получающих антигипертензивную терапию, не достигают целевых значений
АД и остаются в зоне повышенного риска сердечно-сосудистых катастроф. Лекарственный препарат ирбесартан/гидрохлортиазид, включающий два действующих вещества в виде одной формы выпуска – таблетки, представляет собой сбалансированную на основе клинико-фармакологических свойств антигипертензивную комбинацию, одобренную Министерством здравоохранения Республики Беларусь для применения у пациентов по показанию: эссенциальная артериальная гипертензия. Эта комбинация с фиксированными дозами
предназначена для взрослых пациентов, у которых артериальное давление недостаточно контролируется при монотерапии ирбесартаном или гидрохлортиазидом. Клиническая эффективность и безопасность данной комбинации была продемонстрирована в рандомизированных клинических исследованиях, в том числе у пациентов с сочетанием артериальной гипертензии и сахарного диабета 2 типа, метаболическим синдромом, ожирением. Применение комбинации ирбесартан/гидрохлортиазид в виде одной таблетки приводит к более быстрому снижению артериального давления по сравнению с монотерапией ирбесартаном, позволяет большей части пациентов с гипертонией достичь целевого значения
артериального давления, повышает приверженность к терапии. Таким образом, комбинация ирбесартан/гидрохлортиазид является ценным дополнением к арсеналу клиницистов для лечения артериальной гипертензии.

ключевые слова: контроль артериального давления, целевое артериальное давление, комбинированная терапия, ирбесартан, гидрохлортиазид.

для цитирования: И.Н. Кожанова. Фиксированная комбинация ирбесартан/гидрохлортиазид в лечении артериальной гипертензии. Неотложная кардиология и кардиоваскулярные риски, 2023, Т. 7, № 2, С. 2021–2031.

FIXED-DOSE IRBESARTAN/HYDROCHLOROTHIAZIDE COMBINATION IN THE TREATMENT OF ARTERIAL HYPERTENSION

Irina N. Kozhanova

Almost a third of the population of the Republic of Belarus suffers
from elevated blood pressure which results in a high risk of cardiovascular
disease developing. Despite the availability of numerous antihypertensive
drugs, more than 40% of patients receiving antihypertensive therapy
do not achieve target blood pressure levels and continue to be at an increased risk
of cardiovascular events. A fixed combination drug irbesartan/hydrochlorothiazide,
which includes two active ingredients in one dosage form of a tablet, is an antihypertensive combination balanced on the basis of clinical and pharmacological
properties, which is approved by the Ministry of Health of the Republic of Belarus
for use in patients when indicated in case of essential arterial hypertension.
This fixed-dose combination is intended for adult patients whose blood pressure
is not adequately controlled by irbesartan or hydrochlorothiazide monotherapy.
The clinical efficacy and safety of this combination was demonstrated
in randomized clinical trials, including patients with a combination of hypertension
and type 2 diabetes, metabolic syndrome, and obesity. The use of the fixed-dose
combination of irbesartan/hydrochlorothiazide leads to a more rapid decrease
in blood pressure compared to irbesartan monotherapy, allows the majority
of patients with severe hypertension to achieve the target blood pressure, and
increases drug compliance. Thus, the irbesartan/hydrochlorothiazide combination
is a valuable addition to clinicians’ armamentarium for the treatment of hypertension.

keywords: blood pressure control, target blood pressure, combination therapy, irbesartan, hydrochlorothiazide.

for references: Irina N. Kozhanova. Fixed-dose irbesartan/hydrochlorothiazide combination in the treatment of arterial hypertension. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2023, vol. 7, no. 2, pp. 2021–2031.

1. Arterial hypertension in adults: Clinical guidelines Russian Society of Cardiology.
Russian Scientific Medical Society of Therapists, 2022. 161 p.
2. Mills K., Stefanescu A., He J. The global epidemiology of hypertension. Nature Rev
Nephrol, 2020, vol. 16(4), pp. 223-237. doi: 10.1038/s41581-019-0244-2.
3. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension
prevalence and progress in treatment and control from 1990 to 2019: a pooled
analysis of 1201 population-representative s tudies with 10 4 million
participants. Lancet, 2021, vol. 398(10304), pp. 957-980. doi: 10.1016/
S0140-6736(21)01330-1.
4. Lewington S., Clarke R., Qizilbash N., Peto R., Collins R. Age-specific relevance
of usual blood pressure to vascular mortality: a meta-analysis of individual data
for one million adults in 61 prospective studies. Lancet, 2002, vol. 360(9349),
pp. 1903-1913. doi: 10.1016/s0140-6736(02)11911-8.
5. Zhou D., Xi B., Zhao M., Wang L., Veeranki S. Uncontrolled hypertension increases
risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III
linked mortality study. Sci Rep, 2018, vol. 8(1), pp. 9418. doi: 10.1038/s41598-018-
27377-2.
6. Wang Y., Alexander G., Stafford R. Outpatient hypertension treatment, treatment
intensification, and control in Western Europe and the United States. Arch Intern
Med, 2007, vol. 167(2), pp. 141–147. doi: 10.1001/archinte.167.2.141.
7. Cushman W., Ford C., Cutler J., et al. ALLHAT Collaborative Research Group. Success
and predictors of blood pressure control in diverse North American settings:
the antihypertensive and lipid-lowering treatment to prevent heart attack
trial (ALLHAT). J Clin Hypertens, 2002, vol. 4, pp. 393-404. doi: 10.1111/
j.1524-6175.2002.02045.x.
8. STEPS: Prevalence of risk factors for noncommunicable diseases in the Republic
of Belarus, 2020. Copenhagen: WHO Regional Office for Europe, 2022 License:
CCBY-NC-SA 3.0IGO. (in Russian).
9. Unger T., Borghi C., Charchar F., et al. 2020 International Society of Hypertension
global hypertension practice guidelines. J Hypertens, 2020, vol. 38(6), pp. 982–
1004. doi: 10.1097/HJH.0000000000002453.
10. Guideline for the pharmacological treatment of hypertension in adults [electronic
resource]. Geneva: World Health Organization, 2021. Available at: https://www.
who.int/publications/i/item/9789240033986 (accessed 24.10.2023).
11. About the Guidelines for the preclinical and clinical development of combination drugs :
Recommendation of the Board of the Eurasian Economic Commission September 2,
2019 No. 25. Moscow. (in Russian).
12. White W. Cardiovascular risk and therapeutic intervention for the early morning
surge in blood pressure and heart rate. Blood Press Monit, 2001, vol. 6, pp. 63-72.
doi: 10.1097/00126097-200104000-00001.
13. Hansson L. Why don’t you do as I tell you? Compliance and antihypertensive regimens. Int J Clin Pract, 2002, vol. 56, pp. 191-196.
14. Irbesartan + hydrochlorothiazide. General characteristics of the drug. Agreed
by the Ministry of Health of the Republic of Belarus. Order of the Ministry of Health
of the Republic of Belarus dated July 26, 2023 No. 110 (in Russian).
15. Bova A. The place of angiotensin II receptor antagonists in clinical practice. Medical
news, 2009, vol. 6, pp. 11-15. (in Russian).
16. Lindholm L.H., Ibsen H., Dahlöf B., et al. Cardiovascular morbidity and mortality in
patients with diabetes in the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE): a randomised trial against atenolol. Lancet, 2002, vol. 359,
pp. 1004-1010. doi: 10.1016/S0140-6736(02)08090-X.
17. Lindholm L.H., Persson M., Alaupovic P., et al. Metabolic outcome during 1 year
in newly detected hypertensives: results of the antihypertensive treatment
and lipid profile in a North of Sweden efficacy evaluation (ALPINE) study. J Hypertens,
2003, vol. 21, pp. 1563-1574. doi: 10.1097/01.hjh.0000084723.53355.76.
18.Chazova I.E., Ratova L.G. Combination therapy of arterial hypertension. M.:
Media-Medika, 2007, pp. 86-94. (in Russian).
19. Malchikova S.V., Tarlovskaya E.I. Pleiotropic effects of various options for combination therapy for arterial hypertension. Cardiovascular Therapy and Prevention, 2009;
8(2). 33 – 38 p. (in Russian).
20.Bubnova M.G. Pleiotropic activity of antihypertensive drugs in atherothrombogenesis. Nebivolol: empowering and reducing limitations. Cardiovascular Therapy
and Prevention, 2008, vol. 7(6), pp. 94-104. (in Russian).
21.Kochar M., Guthrie R., Triscari J., Kassler-Taub K., Reeves R. Matrix study
of irbesartan with hydrochlorothiazide in mild-to-moderate hypertension.
Am J Hypertens, 1999, vol. 12(8 Pt 1), pp. 797–805. doi: 10.1016/s0895-
7061(99)00053-9.
22.Raskin P., Guthrie R., Flack J., Reeves R., Saini R. The long-term antihypertensive
activity and tolerability of irbesartan with hydrochlorothiazide. J Hum Hypertens,
1999, vol. 13(10), pp. 683-687. doi: 10.1038/sj.jhh.1000888.
23. Howe P., Phillips P., Saini R., Kassler-Taub K. The antihypertensive efficacy of the combination of irbesartan and hydrochlorothiazide assessed by 24-hour ambulatory blood
pressure monitoring. Irbesartan Multicenter Study Group. Clin Exp Hypertens, 1999,
vol. 21(8), pp. 1373-96. doi: 10.3109/10641969909070855.
24.Coca A., Calvo C., Sobrino J., Gómez E., López-Paz J., Sierra C., Bragulat E.,
de la Sierra A. Once-daily fixed-combination irbesartan 300 mg/ hydrochlorothiazide 25 mg and circadian blood pressure profile in patients with essential hypertension. Clin Ther, 2003, vol. 25(11), pp. 2849-64. doi: 10.1016/
s0149-2918(03)80338-7.
25. Neutel J., Saunders E., Bakris G., Cushman W., Ferdinand K., Ofili E., Sowers J., Weber M.
INCLUSIVE Investigators. The efficacy and safety of low- and high-dose fixed
combinations of irbesartan/hydrochlorothiazide in patients with uncontrolled systolic blood pressure on monotherapy: the INCLUSIVE trial. J Clin
Hypertens (Greenwich), 20 05, vol. 7(10), pp. 578-586. doi: 10.1111/
j.1524-6175.2004.04720.x.
26.Sowers J., Neutel J., Saunders E., et al. Antihypertensive efficacy of Irbesartan/
HCTZ in men and women with the metabolic syndrome and type 2 diabetes.
J Clin Hypertens (Greenwich), 2006, vol. 8(7), pp. 470-480. doi: 10.1111/
j.1524-6175.2006.05486.x.
27. Schrader J., Bramlage P., Luders S., Thoenes M., Schirmer A., Paar D. BP goal achievement in patients with uncontrolled hypertension: results of the treat-to-target
post-marketing survey with irbesartan. Clin Drug Investig, 2007, vol. 27(11),
pp. 783-796. doi: 10.2165/00044011-200727110-00005.
28.Turnbull F. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet, 2003, vol. 362(9395), pp. 1527-1535. doi: 10.1016/
s0140-6736(03)14739-3.
29. Neutel J., Franklin S., Oparil S., Bhaumik A., Ptaszynska A., Lapuerta P. Efficacy and safety
of irbesartan/HCTZ combination therapy as initial treatment for rapid control
of severe hypertension. J Clin Hypertens (Greenwich), 2006, vol. 8(12), pp. 850-857.
doi: 10.1111/j.1524-6175.2006.05676.x.
30. Neutel J., Franklin S., Lapuerta P., Bhaumik A., Ptaszynska A. A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ
monotherapy in the treatment of moderate hypertension. J Hum Hypertens, 2008,
vol. 22, pp. 266-274. doi: 10.1038/sj.jhh.1002293.
31. Dezii C. A retrospective study of persistence with single-pill combination therapy
vs. concurrent two-pill therapy in patients with hypertension. Manag Care, 2000,
vol. 9(9 Suppl), pp. 2-6.
32. Gerbino P., Shoheiber O. Adherence patterns among patients treated with fixed-dose
combination versus separate antihypertensive agents. Am J Health Syst Pharm, 2007,
vol. 64(12), pp. 1279-1283. doi: 10.2146/ajhp060434.
33. Fouassier D., Blanchard A., Fayol A., Bobrie G., Boutouyrie P., Azizi M., Hulot J.S.
Sequential nephron blockade with combined diuretics improves diastolic function
in patients with resistant hypertension. ESC Heart Fail, 2020, vol. 7(5), pp. 2561-2571. doi:
10.1002/ehf2.12832.
34. Napoli C., Omboni S., Borghi C. ; ZAMES (Zofenopril in Advanced MEtabolic Syndrome) Study Group. Fixed-dose combination of zofenopril plus hydrochlorothiazide
vs. irbesartan plus hydrochlorothiazide in hypertensive patients with established
metabolic syndrome uncontrolled by previous monotherapy. The ZAMES study
(Zofenopril in Advanced MEtabolic Syndrome). J Hypertens, 2016, vol. 34(11),
pp. 2287-2297. doi: 10.1097/HJH.0000000000001079.
35. Vitale C., Marazzi G., Iellamo F., Spoletini I., Dall’Armi V., Fini M., Volterrani M. Effects
of nebivolol or irbesartan in combination with hydrochlorothiazide on vascular
functions in newly-diagnosed hypertensive patients: the NINFE (Nebivololo, Irbe
sartan Nella Funzione Endoteliale) study. Int J Cardiol, 2012, vol. 155(2), pp. 279-284.
doi: 10.1016/j.ijcard.2011.10.099.
36.Asmar R., Oparil S. Comparison of the antihypertensive efficacy of irbesartan/HCTZ and valsar tan/HCTZ combination therapy: impac t of age and
gender. Clin Exp Hypertens, 2 010, v o l . 32(8), p p . 49 9 - 5 03. d o i :
10.3109/10641963.2010.496509.
37. Neutel J.M., Smith D. Ambulatory blood pressure comparison of the anti-hypertensive efficacy of fixed combinations of irbesartan/hydrochlorothiazide and losartan/
hydrochlorothiazide in patients with mild-to-moderate hypertension. J Int Med Res,
2005, vol. 33(6), pp. 620-631. doi: 10.1177/147323000503300603.
38.Koroleva A.A., Zhuravkov Yu.L. Nephroprotection in a patient with diabetes mellitus
and arterial hypertension: focus on irbesartan. Medical News, 2020, no. 7(310),
pp. 47-52. (in Russian).

Полнотекстовая статья

Скачать статью

Формат файла: pdf (285.61 Кб)

→ Главная → 2023 том 7, №2