arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2018-24-6-716-722arthyper-1778Research ArticleМНЕНИЕ ЭКСПЕРТАEXPERT OPINIONТройная фиксированная комбинация антигипертензивных препаратов — зеленый свет в контексте новых Европейских рекомендаций 2018 годаTriple fixed combination for hypertension treatment — a green light in the new european Guidelines 2018КонрадиА. О.KonradiA. O.

Конради Александра Олеговна — доктор медицинских наук, профессор, член-корреспондент Российской академии наук, заместитель генерального директора по научной работе  ФГБУ «НМИЦ им. В. А. Алмазова» Минздрава России; директор Института трансляционной медицины, Университет ИТМО.

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

Aleksandra O. Konradi, MD, PhD, DSc, Professor, Corresponding Member of RAS; the Deputy Director General of Science, Almazov National Medical Research Centre; Head, Translational Medicine Institute; ITMO University.

2 Akkuratov street, St Petersburg, 197341. 

konradi@almazovcentre.ruФедеральное государственное бюджетное учреждение   «Национальный медицинский исследовательский центр  имени В. А. Алмазова» Министерства здравоохранения; Университет ИТМО.РоссияAlmazov National Medical Research Centre; ITMO University.Russian Federation201809012019246716722Copyright © Конради А.О., 20192019Конради А.О.Konradi A.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1778

Необходимость комбинированной терапии у подавляющего большинства пациентов со стойкой артериальной гипертензией уже давно стала очевидной, а понижение целевого уровня артериального давления до 130 и 80 мм рт. ст. диктует необходимость применения еще большего абсолютного числа препаратов у одного и того же пациента для достижения требуемого эффекта. В связи с этим все чаще возникает необходимость не только в двойной, но и в тройной терапии, и создание тройных рациональных фиксированных комбинаций становится крайне актуальным. Их потенциально широкое применение подтверждается и позицией европейских экспертов, отраженной в новой редакции клинических рекомендаций Европейского общества кардиологов. В статье рассматриваются основные вопросы, касающиеся тактики перевода пациентов на фиксированные комбинации и их рационального выбора. 

The majority of patients with stable arterial hypertension require combination therapy which is supported by the clinical evidence. The established target levels of blood pressure below 130/80 mmHg are challenging and demand multiple drug combinations in a single patient. Therefore, the use of dual and triple combination therapy is getting wider, and rational triple fixed combinations are highly relevant. The updated guidelines on the diagnostics, management and treatment of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology confirm and recommend early and wider use of the fixed-dose drug combinations. The paper reviews the main practical issues of the use of combination therapy, including key questions of the change from free dose to fixed dose combinations and their rational choice.

артериальная гипертензиякомбинированная терапиятройная терапияорганопротекцияпериндоприлиндапамидамлодипинhypertensioncombination therapytriple combinationorganoprotectionperindoprilindapamideamlodipineReferencesWilliams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier 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/ehy339Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier 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/ehy339Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219. doi: 10.1093/eurheartj/eht151Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219. doi: 10.1093/eurheartj/eht151Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122(3):290–300. doi: 10.1016/j.amjmed.2008.09.038Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122(3):290–300. doi: 10.1016/j.amjmed.2008.09.038Weir MR, Hsueh WA, Nesbitt SD, Littlejohn TJ III, Graff A, Shojaee A et al. A titrate-to-goal study of switching patients uncontrolled on antihypertensive monotherapy to fixed-dose combinations of amlodipine and olmesartan medoxomil ± hydrochlorothiazide. J Clin Hypertens (Greenwich). 2011;13(6):404–412. doi: 10.1111/j.1751-7176.2011.00437.xWeir MR, Hsueh WA, Nesbitt SD, Littlejohn TJ III, Graff A, Shojaee A et al. A titrate-to-goal study of switching patients uncontrolled on antihypertensive monotherapy to fixed-dose combinations of amlodipine and olmesartan medoxomil ± hydrochlorothiazide. J Clin Hypertens (Greenwich). 2011;13(6):404–412. doi: 10.1111/j.1751-7176.2011.00437.xVolpe M, Christian Rump L, Ammentorp B, Laeis P. Efficacy and safety of triple antihypertensive therapy with the olmesartan/amlodipine/hydrochlorothiazide combination. Clin Drug Investig. 2012;32(10):649–664. doi: 10.2165/11636320-000000000-0000Volpe M, Christian Rump L, Ammentorp B, Laeis P. Efficacy and safety of triple antihypertensive therapy with the olmesartan/amlodipine/hydrochlorothiazide combination. Clin Drug Investig. 2012;32(10):649–664. doi: 10.2165/11636320-000000000-0000Corrao G, Parodi A, Zambon A, Heiman F, Filippi A, Cricelli C et al. Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice. J Hypertens. 2010;28(7):1584–1590. doi: 10.1097/HJH.0b013e328339f9faCorrao G, Parodi A, Zambon A, Heiman F, Filippi A, Cricelli C et al. Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice. J Hypertens. 2010;28(7):1584–1590. doi: 10.1097/HJH.0b013e328339f9faGupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. 2010;55(2):399–407. doi: 10.1161/HYPERTENSIONAHA.109.139816Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. 2010;55(2):399–407. doi: 10.1161/HYPERTENSIONAHA.109.139816Jung O, Gechter JL, Wunder C, Paulke A, Bartel C, Geiger H et al. Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens. 2013;31(4):766–774. doi: 10.1097/HJH.0b013e32835e228Jung O, Gechter JL, Wunder C, Paulke A, Bartel C, Geiger H et al. Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens. 2013;31(4):766–774. doi: 10.1097/HJH.0b013e32835e2282017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–177. doi: 10.1093/eurheartj/ehx3932017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–177. doi: 10.1093/eurheartj/ehx393Gupta P, Patel P, Horne R, Buchanan H, Williams B, Tomaszewski M. How to screen for non-adherence to antihypertensive therapy. Curr Hypertens Rep. 2016;18(12):89.Gupta P, Patel P, Horne R, Buchanan H, Williams B, Tomaszewski M. How to screen for non-adherence to antihypertensive therapy. Curr Hypertens Rep. 2016;18(12):89.Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redon J, Mancia G. The polypill in cardiovascular prevention: evidence, limitations and perspective - position paper of the European Society of Hypertension. J Hypertens. 2017;35(8):1546–1553. doi: 10.1097/HJH.0000000000001390Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redon J, Mancia G. The polypill in cardiovascular prevention: evidence, limitations and perspective - position paper of the European Society of Hypertension. J Hypertens. 2017;35(8):1546–1553. doi: 10.1097/HJH.0000000000001390Chalmers J, Arima H, Woodward M, Mancia G, Poulter N, Hirakawa Y et al. Effects of combination of perindopril, indapamide, and calcium channel blockers in patients with type 2 diabetes mellitus: results from the Action In Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial. Hypertension. 2014;63(2):259-264. doi: 10.1161/HYPERTENSIONAHA.113.02252Chalmers J, Arima H, Woodward M, Mancia G, Poulter N, Hirakawa Y et al. Effects of combination of perindopril, indapamide, and calcium channel blockers in patients with type 2 diabetes mellitus: results from the Action In Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial. Hypertension. 2014;63(2):259-264. doi: 10.1161/HYPERTENSIONAHA.113.02252

The authors declare that there are no conflicts of interest present.