A fixed combination of amlodipine and losartan: effectiveness and safety in abnormal weather conditions in patients with arterial hypertension

Actuality. The effect of drugs on adaptation to abnormal temperatures is one of the most important questions put to practical medicine by the heat waves of recent years. One of the controversial issues - safety of use during the heat wave of calcium channel blockers (ACC) and blockers of receptors for angiotensin II (ARBS). The goal is to evaluate the efficacy and security of treatment of patients with arterial hypertension (AH) during the heat wave of a fixed combination of ARBS+ACC (Lortenza, KRKA). Materials and methods. Included 26 patients with hypertension 1 and 2 degrees from 42 to 81 years. All patients underwent measurement of office blood pressure, electrocardiography, body sphygmography with the determination of the pulse wave velocity and selectively CAVI, biochemical analysis of blood, estimation of osmolarity of blood, questionnaire: visual analogue scale, a questionnaire for patients exposed to heat, the test of adherence to treatment Moriscos-Green. Estimated diaries of self-control of blood pressure. The inclusion visit took place in spring 2016, 1st visit was in May - June 2016, 2nd - during heat waves, 3rd - September - October 2016. Results. The observed decrease in systolic blood pressure and diastolic blood pressure (p=0.000) to the target values, preserved for the whole period of observation. According to the diaries of self-control of blood pressure controlled blood pressure 81% of patients. During a heat wave, this value decreased to 58%, in autumn - to 63%. The 3rd visit achieved a reduction in heart rate at -6.0 (-11.1; and 2.8) beats/min; p=0.007. A noticeable decrease of the pulse wave velocity from 15.2±3.4 to 14.4 V±3.0 m/s; p=0.01 and CAVI in of-2.1 (to -2.9; -0.65); p=0.01; the decline in uric acid level c of 415.3 to 346.2 mmol/l (p=0.04) and creatinine on the 2nd visit compared to baseline (p=0.02). Electrolyte shifts and increasing the osmolarity of the blood during heat waves have not been identified. There is a growing commitment therapy (p=0.04) and quality of life to 20.0 (7.4; 23.3); p=0.000 by visual analogue scale. Conclusion. Fixed combination of losartan and amlodipine (Lorenza) is an effective, safe and may be recommended for patients receiving AG in the hottest period.

arterial hypertension, heat wave, amlodipine, losartan

1. Stöllberger C, Lutz W, Finsterer J. Heat - related side - effects of neurological and non - neurological medication may increase heat wave fatalities. Eur J Neurol 2009; 16 (7): 879-82.

2. Kukkonen-Harjula K, Kauppinen K. Health effects and risks of sauna bathing. Int J Circumpolar Health 2006; 65 (3): 195-205.

3. Vanakoski J, Seppälä T. Effects of a Finnish sauna on the pharmacokinetics and haemodynamic actions of propranolol and captopril in healthy volunteers. Eur J Clin Pharmacol 1995; 48 (2): 133-7.

4. Curriero F, Heiner K.S, Samet J.M et al. Temperature and mortality in 11 cities of the Eastern United States. Am J Epidemiol 2002; 155: 80-7.

5. Kilbourne E.M. Heat - related illness: current status of prevention efforts. Am J Prevent Med 2002; 22: 328-9.

6. Mirabelli M.C, Richardson D.B. Heat - related fatalities in North Carolina. Am J Pub Health 2005; 95: 635-7.

7. Stafoggia M, Forastiere F, Agostini D et al. Vulnerability to heat - related mortality: a multicity, population - based, case - crossover analysis. Epidemiology 2006; 17: 315-23.

8. Hausfater Р, Megarbane B, Dautheville S et al. Prognostic factors in non - exertional heat stroke. Intensive Care Med 2010; 36 (2): 272-80.

9. Смирнова М.Д., Фофанова Т.В., Яровая Е.Б., Агеев Ф.Т. Прогностические факторы развития сердечно - сосудистых осложнений во время аномальной жары 2010 г. (когортное наблюдательное исследование). Кардиологический вестн. 2016; XI (1): 43-51.

10. Чазова И.Е., Агеев Ф.Т., Смирнова М.Д. и др. Оценка эффективности и безопасности фиксированной комбинации амлодипина и периндоприла (препарат Престанс) у больных артериальной гипертензией во время летней жары // Системные гипертензии. 2014; 11 (2): 17-22.

11. Диагностика и лечение артериальной гипертензии (Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов). Авторы (рабочая группа): И.Е.Чазова, Л.Г.Ратова, С.А.Бойцов, Д.В.Небиеридзе // Системные гипертензии. 2010; 3: 5-26.

12. Park C.G, Youn H.J, Chae S.C et al. Evaluation of the dose - response relationship of amlodipine and losartan combination in patients with essential hypertension: an 8-week, randomized, double - blind, factorial, phase II. Am J Cardiovasc Drugs 2012; 12: 35-47.

13. Law M.R, Wald N.J, Morris J.K, Jordan R.E. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. Br Med J 2003; 326: 1427.

14. Орлова Я.А., Нуралиев Э.Ю., Яровая Е.Б. и др. Снижение артериальной ригидности ассоциировано с благоприятным прогнозом у мужчин с ИБС. Сердце: журнал для практикующих врачей. 2009; 8 (5): 261-5.

15. Guerin A.P, Blacher J, Pannier B et al. Impact of aortic stif fness attenuation on survival of patients in end - stage renal failure. Circulation 2001; 103 (7): 987-92.

16. Агеев Ф.Т., Смирнова М.Д., Свирида О.Н. и др. Влияние летней жары на состояние здоровья пациентов с умеренным и высоким риском сердечно - сосудистых осложнений. Кардиоваскулярная терапия и профилактика. 2013; 12 (4): 56-61.

17. Shahin Y, Khan J.A, Chetter I. Angiotensin converting enzyme inhibitors effect on arterial stiffness and wave reflections: A meta - analysis and meta - regression of randomised controlled trials. Atherosclerosis 2012; 221: 18-33.

18. London G.M, Pannier B, Guerin A.P et al. Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end - stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade. Circulation 1994; 90: 2786-96.

19. Burnier M, Waeber B, Brunner H.R. Clinical pharmacology of the angiotensin II receptor antagonist losartan potassium in healthy subjects. J Hypertens (Suppl.) 1995; 13: S23-8.

20. Suliman M.E, Johnson R.J, Garcia-Lopez E et al. J-shaped mortality relationship for uric acid in CKD. Am J Kidney Dis 2006; 48: 761-71.

21. Dahlоf B, Devereux R.B, Kjeldsen S.E et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995-1003.

22. Гора Е.П. Экология человека. М.: Дрофа, 2007.

23. Умидова З.И. Физиология и патология сердечно - сосудистой системы в условиях жаркого климата. Ташкент: Госиздат УзСССР, 1949.

24. Miyata M, Kihara T, Kubozono T et al. Beneficial effects of Waon therapy on patients with chronic heart failure: Results of a prospective multicenter study. J Cardiology 2008; 52: 79-85.

25. Смирнова М.Д., Свирида О.Н., Фофанова Т.В. и др. Влияние летней жары на качество жизни, состояние гемодинамики, электролитного баланса и окислительного стресса у больных с умеренным и высоким риском сердечно - сосудистых осложнений и больных ИБС. РМЖ. 2014; 22 (18): 1320-4.