Anti-hypertensive strategies in patients with MEtabolic parameters, DIabetes mellitus and/or NephropAthy (the M E D I N A study)

Abstract

Aims. The primary questions asked by the MEDINA (MEtabolic parameters, DIabetes mellitus and NephropAthy) study are: 1) Do angiotensin converting enzyme inhibitors (ACE-I) have any advantages over angiotensin receptor blockers (ARB)? 2) Should the other drug for combination be a diuretic or a calcium-channel blocker (CCB)? 3) How are the risks reduced by the co administration of a statin? Methods. A total of 439 hypertensive patients with metabolic syndrome and/or diabetes mellitus were randomized to 2 groups: group 1 -ramipril (ACE-I) or perindopril and group 2 -losartan (ARB). Hydrochlorothiazide (diuretic) or amlodipine (CCB) were added to both groups. As a third step, a statin was added.Results. Blood pressure decreased 24.1/13.3 mmHg in the ACE inhibitor group and 25.9/13.5 in the losartan group. The difference was insignificant. Adding either hydrochlorothiazide or amlodipin was equally effective. There were no significant differences on metabolic parameters in the trial arms. Cholesterol level decreased by 0.95 mmol/L in the ACE-I group and 1.02 mmol/L in the ARB group (ns). Conclusion. MEDINA has so far confirmed the equivalence of ACE-I and ARB in hypertension treatment. Adding either diuretic or CCB was equally effective. Our data support the current recommendations on adding a statin to reduce cardiovascular risk.

Utilisation Analysis of Antihypertensive Drugs in Bosnia and Herzegovina for the Time-period 2013-2015

“…have reviewed recommendations for combination therapy and fixed combinations in treatment of hypertension, according to the guidelines of ESH/ESC and CSH from 2013. Most often recommended are double combinations which include ACE inhibitors + Ca channel antagonists; angiotensin II receptor antagonists + diuretics; Ca channel antagonists + diuretics ( 15 ).…”

Раміприл У Пацієнтів З Артеріальною Гіпертензією Як Монотерапія Або В Комбінації З Гідрохлортіазидом

“…Однак максимальний ренопротекторний ефект інгібітору АПФ спостерігався у хворих із початковими стадіями ниркової дисфункції, коли тривале лікування (протягом 36 місяців) приводило до стабілізації рівня клубочкової фільтрації та запобігання розвитку кінцевої стадії ХНН. Ренопротекторний ефект раміприлу був однаково виражений у хворих з АГ та без неї, але найбільший ефект спостерігався у хворих з АГ і значною протеїнурією (понад 2 г за добу) [9,36].…”

“…Комбінована АГ терапія для досягнення цільових рівнів АТ була необхідна в 4/5 пацієнтів. Після одного року терапії не спостерігалося жодних несприятливих ефектів ГХТЗ щодо підвищення холестерину або нових випадків цукрового діабету [8,13,35,36].…”

Characteristics and control of the 24‐hour ambulatory blood pressure in patients with metabolic syndrome

“…12,22,25 Between ACEIs and ARBs, no significant difference was found in their antihypertensive effect among patients with MetS in several small-sized clinical trials that used office BP measurement. 43,44 The To improve BP control at night and in the morning, some researchers proposed to prescribe at least one antihypertensive drug at bedtime.…”

“…Between ACEIs and ARBs, no significant difference was found in their antihypertensive effect among patients with MetS in several small‐sized clinical trials that used office BP measurement 43,44 . The Zofenopril in Advanced MEtabolic Syndrome (ZAMES) study is a multicenter, randomized, double‐blind clinical trial conducted in Italy and Romania 43 .…”