Vol. 6 (04) pp. 1238-1249 DOI: 10.21474/IJAR01/6973

ANTIHYPERTENSIVE EFFECTIVENESS OF A FIXED-DOSE COMBINATION OF RAMIPRIL/HYDROCHLOROTHIAZIDE IN THE GULF REGION: RESULTS FROM THE PACHA REGISTRY.

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  • Consultant Internist in Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait.
  • Medical Manager, Sanofi Gulf Affiliate, Dubai, United Arab Emirates.
  • Consultant Physician, Thumbay Hospital, Dubai, United Arab Emirates.
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Abstract

Ramipril/hydrochlorothiazide (HCTZ) combined therapy can be used for the treatment of hypertension. We determined the percentage of patients who achieved optimum blood pressure control according to 2007 ESH recommendations after 3 months treatment with fixed-dose combination (FDC) ramipril/HCTZ and assessed tolerance to treatment. This non-interventional, prospective, multicentre, observational study was conducted in three Gulf countries (United Arab Emirates, Kuwait and Qatar). Patients with uncontrolled hypertension were treated with FDC ramipril/HCTZ (10/12.5 mg or 10/25 mg) for 3 months. Systolic (SBP) and diastolic (DBP) blood pressure were measured at baseline and after 1 and 3 months of treatment. Primary endpoint was the number of patients who achieved the target blood pressure of <140/90 mmHg (or <130/80 mmHg in diabetics) after 3 months of treatment. Secondary endpoints were the reduction in mean SBP and DBP in different patient subgroups and overall safety. A total of 409 patients were included in the efficacy analysis. The majority of patients (n=324, 79.2%) were given FDC ramipril/HCTZ 10/12.5 mg, while 85 (20.8%) received ramipril/HCTZ 10/25 mg. Ninety-four (23%) of these 409 patients had diabetes. There was no significant difference in the daily dose of ramipril/HCTZ FDC between patients with and without diabetes (78.7% of patients with diabetes and 79.4% of patients without received ramipril/HCTZ 10/12.5 mg; p = 0.89). After three months of treatment, 260 (63.6%; 95%CI: 58.9-68.3) ‎patients achieved the blood pressure target and 149 (36.4%) did not. The proportion of patients achieving the blood pressure target was significantly higher at three months than at one month (p<0.001). The proportion of patients achieving the blood pressure target was ‎considerably higher in non-diabetic patients than in those with diabetes (81.3% vs 4.3% respectively; p<0.001), irrespective of the ramipril/HCTZ dose. In conclusion, 10/12.5 mg and 10/25 mg FDC ramipril/HCTZ was effective at reducing both SDP and DBP to below guideline target levels in hypertensive patients, including those with diabetes, within 3 months of treatment. Ramipril/HCTZ was well tolerated.

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How to Cite This Article

Mohammed Qurtom, Rizan Amaneddine and Salwa Abdelzaher Mabrouk Ibrahim. (2018); ANTIHYPERTENSIVE EFFECTIVENESS OF A FIXED-DOSE COMBINATION OF RAMIPRIL/HYDROCHLOROTHIAZIDE IN THE GULF REGION: RESULTS FROM THE PACHA REGISTRY., International Journal of Advanced Research (IJAR), 6 (04), 1238-1249, ISSN 2320-5407. DOI: https://doi.org/10.21474/IJAR01/6973

Corresponding Author

Dr. Mohammed Qurtom
Consultant Internist in Mubarak Al-Kabeer Hospital

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References

  1. Aronow WS, Fleg JL, Pepine CJ et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Soc Hypertens 2011; 5:259-352.
  2. Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst Rev 2013; 10:CD008277.
  3. Bosch J, Yusuf S, Pogue J et al. Use of ramipril in preventing stroke: double blind randomised trial. 2002; 324:699-702.
  4. Chockalingam A, Campbell NR, Fodor JG. Worldwide epidemic of hypertension. Can J Cardiol. 2006; 22:553-5.
  5. Chobanian AV, Bakris GL, Black HR et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42:1206-52.
  6. Dickinson HO, Mason JM, Nicolson DJ et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24:215-33.
  7. Ezzati M, Lopez AD, Rodgers A et al. Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360:1347-60.
  8. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31:1925-38.
  9. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: The National Health and Nutrition Examination Survey, 2001 to 2010. Circulation 2012; 126:2105-14.
  10. Hajjar I, Kotchen JM, Kotchen TA. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health 2006; 27:465-90.
  11. Heidbreder D, Froer KL, Breitstadt A et al. Combination of ramipril and hydrochlorothiazide in the treatment of mild to moderate hypertension: Part 1- A double-blind, comparative, multicenter study in non-responders to ramipril monotherapy. Clin Cardiol 1992; 15:904-10.
  12. Integrated Management of Cardiovascular Risk. Report of a WHO Meeting, Geneva, July 2002, WHO Press.
  13. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507-20.
  14. Kalra S, Kalra B, Agrawal N. Combination therapy in hypertension: An update. Diabetol Metabol Syndr 2010; 2:44.
  15. Mancia G, De Baker G, Dominiczak A et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007; 25:1751-62.
  16. Messerli FH, Makani H, Benjo A et al. ‎Antihypertensive efficacy of hydrochlorothiazide as evaluated by ambulatory blood pressure ‎ monitoring: a meta-analysis of randomized trials. J Am Coll Cardiol 2011;‎‎ 57:590-600. ‎
  17. Morgan TO, Anderson AI, MacInnis RJ. ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. Am J Hypertens 2001; 14:241-7.
  18. National Heart, Lung and Blood Institute. Risk factors for high blood pressure. http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk (last accessed 01/04/2016)
  19. National Clinical Guideline Centre (UK). Hypertension: the clinical management of primary hypertension in adults: update of clinical guidelines 18 and 34. London: Royal College of Physicians (UK); 2011. Available from: http://www.ncbi.nlm.nih.gov/books/NBK83274/ (last accessed 06/04/2016).
  20. Neal B, MacMahon S, Chapman N. Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomized trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet. 2000; 356:1955-64.
  21. Omboni S, Malacco E, Mallion J-M, Volpe Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines. Clin Interv Aging 2015; 10:1575?86.
  22. Oigman W, Gomes MA, Pereira-Barretto AC et al. Efficacy and safety of two ramipril and hydrochlorothiazide fixed-dose combination formulations in adults with stage 1 or stage 2 arterial hypertension evaluated by using ABPM. Clin Ther 2013; 35:702-10.
  23. Okpechi IG, Schoeman HS, Longo-Mbenza B et al. Achieving blood preSsure goals sTudy in uncontrolled hypeRtensive pAtients treated with a fixed-dose combination of ramipriL/hydrochlorothiazide: the ASTRAL study. Cardiovasc J Afr 2011; 22:79-84.
  24. Riaz K, Batuman V. Hypertension. 2011. Available at: http://emedicine.medscape.com/article/241381-overview (last accessed 01/04/2016).
  25. Scholze J, Breitstadt A, Cairns V et al. Short report: ramipril and hydrochlorothiazide combination therapy in hypertension: a clinical trial of factorial design. The East Germany Collaborative Trial Group. J Hypertens 1993; 11:217-21.
  26. Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med 2011; 154:541-8.
  27. Weber MA, Schiffrin EL, White WBet al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich) 2014; 16:14?26.
  28. World Health Report 2002. Reducing risks, promoting healthy life. World Health Organization; Geneva: 2002
  29. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, Ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. New Eng J Med 2000; 342:145-53.
  30. Zanchetti A, Grassi G, Mancia G. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens 2009; 27:923-34

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