Efficacy of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease

Objective: to study the comparative efficacy and safety of the use of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease. Materials and methods: 85 patients with a verified diagnosis of arterial hypertension and chronic obstructive pulmonary disease were examined, the average age of patients was 60.9±1.1 years; 54% of men and 46% of women who were prescribed two variants of combination therapy (group A amlodipine/perindopril, group B amlodipine/valsartan). At the first visit and 6 weeks after the start of therapy, all patients underwent clinical, laboratory and instrumental examinations in accordance with the current protocols for the treatment of hypertension and chronic obstructive pulmonary disease, a daily blood pressure study, the frequency of depressive disorders was assessed on the Beck scale and the quality of life according to the SF-36 questionnaire. Results: the use of both antihypertensive regimens in comorbid patients was accompanied by comparable antihypertensive efficacy of therapy, contributed to the same statistically significant decrease in daily, day and night blood pressure indicators. The analysis of the indicators of the function of external respiration revealed the absence of negative dynamics of spirographic indicators in both groups. The use of both combinations of antihypertensive drugs contributed to the statistically identical recovery of both physical and mental components of the patient's quality of life. The improvement in the quality of life of comorbid patients was accompanied by a decrease in the manifestations of depressive disorders in the studied patients according to the Beck scale. The average score of the Beck scale in patients of group A before treatment was 11.6±0.97, against the background of therapy — 9.1±0.77, p <0.001. In patients of group B, it decreased from 13.0±1.06 to 9.3±0.78, p <0.001. Conclusion: the use of antihypertensive combined strategies amlodipine / perindopril and amlodipine / valsartan for the treatment of hypertension in patients with chronic obstructive pulmonary disease is characterized by comparable effectiveness of blood pressure control, which is confirmed by the data of daily monitoring of blood pressure. Effective control of blood pressure was accompanied by statistically significant (p<0.001) positive dynamics of most indicators of the quality of life of patients in both study groups and the severity of manifestations of depression. Any of the studied combinations, which demonstrated comparable efficacy and tolerability in the study, can be recommended as the first step of antihypertensive therapy in patients with arterial hypertension in combination with chronic obstructive pulmonary disease.

1. Аксенова Т.А., Горбунов В.В. Кардиогемодинамические нарушения при коморбидности хронической обструктивной болезни легких и гипертонической болезни. Болезни органов дыхания (Прил. к журн. Consilium Medicum). 2018;19-23. DOI: 10.26442/2619-0079.2018.19-23.

2. Аксенова Т.А., Горбунов В.В., Царенок С.Ю. Скорость распространения пульсовой волны и другие показатели артериальной ригидности при коморбидности артериальной гипертензии и хронической обструктивной болезни легких. Терапевтический архив. 2018;3:10-15. DOI:10.26442/terarkh201890310-1.

3. Диагностика и лечение пациентов с хронической обструктивной болезнью легких и артериальной гипертензией. Клинические рекомендации. 2017.

4. Pellicori P., Cleland J. G., Clark A. L. Chronic Obstructive Pulmonary Disease and Heart Failure: A Breathless Conspiracy. Heart failure clinics. 2020;16(1):33-44. DOI: 10.1016/j.hfc.2019.08.003.

5. Oliva R. V. A Review on the Status of Hypertension in Six Southeast Asian Countries. Hypertension. 2019;5(2):45-48. DOI: 10.15713/ins.johtn.0151.

6. Vukadinovic D, Vukadinovic AN, Lavall D, Laufs U, Wagenpfeil S, Bohm M. Rate of Cough During Treatment With Angiotensin-Converting Enzyme Inhibitors: A Meta-Analysis of Randomized Placebo-Controlled Trials. Clin Pharmacol Ther. 2019;105(3):652-660. DOI: 10.1002/cpt.1018.

7. Vasileiadis IE, Goudis CA, Giannakopoulou PT, Liu T. Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: A Promising Medication for Chronic Obstructive Pulmonary Disease? COPD. 2018;15(2):148-156. DOI: 10.1080/15412555.2018.1432034.

8. Fuster V, Frazer J, Snair M, Vedanthan R, Dzau V; Committee on Global Health and the Future of the United States: A Report of the National Academies of Sciences, Engineering and Medicine. The Future Role of the United States in Global Health: Emphasis on Cardiovascular Disease. J Am Coll Cardiol. 2017;70(25):3140-3156. DOI: 10.1016/j.jacc.2017.11.009.

9. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339. Erratum in: Eur Heart J. 2019;40(5):475. PMID: 30165516.

10. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786. DOI: 10.15829/1560-4071-2020-3-3786.

11. Чазова И.Е., Жернакова Ю.В. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1):6-31. DOI: 10.26442/2075082Х.2019.1.190179.

12. Струтынский А. Длительное лечение больных хронической обструктивной болезнью легких и aртeриaльнoй гипертензией фиксированной комбинацией периндоприла и амлодипина. Врач. 2015;8:45-51.

13. Викторова И.А., Багишева Н.В., Моисеева М.В., Мор-дык А.В., Ароян А.Р., Филипенко Г.В., и др. Оптимизация гипотензивной терапии у коморбидных пациентов с туберкулезом легких, хронической обструктивной болезнью легких и артериальной гипертензией. Сибирское медицинское обозрение. 2020;2(122):36-44. DOI: 10.20333/2500136-2020-2-36-44.

14. Никитин В.А., Гостева Е.В., Пышнограева Л.В., Васильева Л.В. Комбинированная терапия бисопрололом и амлодипином у больных хронической обструктивной болезнью легких с артериальной гипертензией. Пульмонология. 2015;25(4):440-446. DOI: 10.18093/0869-0189-2015-254-440-446.

15. Погорелов В.Н., Брек С.В., Денисова И.В. Антигипертензивная терапия больных хроническими обструктивными заболеваниями. Експериментальна і клінічна медицина. 2013;2:105-109.

16. Меньшикова И.Г., Магаляс Е.В., Скляр И.В., Лоскутова Н.В. Эффективность комплексной терапии при коморбдности артериальной гипертонии и хронической обструктивной болезни легких. Амурский медицинский журнал. 2021;1(31):49-53. DOI: 10.24412/2311-5068-2021-1-49-53.

17. Пилясова О. В., Стаценко М. Е. Особенности вариабельности сердечного ритма у больных артериальной гипертензией и хронической обструктивной болезнью легких. Волгоградский научно-медицинский журнал. 2008:4(20):41-43. eLIBRARY ID: 23378528.

18. Curtis KJ, Meyrick VM, Mehta B, Haji GS, Li K, Montgomery H, et al. Angiotensin-Converting Enzyme Inhibition as an Adjunct to Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2016;194(11):1349-1357. DOI: 10.1164/rccm.201601-0094OC.

19. Kchaou, K., Kammoun, R., Chaabouni, M., Trabelsi, H., Triki, L., Kammoun, I., et al. Impact of concomitant cardiovascular diseases on functional status and quality of life of patients with Chronic Obstructive Pulmonary Diseases. European Respiratory Journal. 2019;54(Suppl. 63):PA4489. DOI: 10.1183/13993003.

20. Martinez Rivera C, Costan Galicia J, Alcazar Navarrete B, Garcia-Polo C, Ruiz Iturriaga LA, Herrejon A, et al. Factors Associated with Depression in COPD: A Multicenter Study. Lung. 2016;194(3):335-43. DOI: 10.1007/s00408-016-9862-7.