Cicero Arrigo F G, Fogacci Federica, Rizzoli Elisabetta, D'Addato Sergio, Borghi Claudio
Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, Via Albertoni 15, 40138 Bologna, Italy.
IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy.
J Clin Med. 2021 Dec 17;10(24):5921. doi: 10.3390/jcm10245921.
The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized Italian cohort. We considered the data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2012 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with <3 or ≥3 antihypertensive drugs without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with Perindopril/Amlodipine/Indapamide, ACE-inhibitors (other than perindopril)/CCBs/Thiazide or ARBs/CCBs/Thiazide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive treatments. The long-term (12 years) effects of the different antihypertensive treatments were compared among the pre-defined groups. During the observation period, there was a trend towards increase in both systolic and diastolic blood pressure (BP) in all the investigated subgroups ( for trend <0.05), but in the subgroup of patients treated with Perindopril/Amlodipine/Indapamide, such increase was significantly lower than in the other groups ( < 0.05). The combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with significantly lower diastolic BP ( < 0.05) and more strictly controlled lipid pattern than other triple combination of anti-hypertensive medications. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow up none of them developed type 2 diabetes, nor had a need for a greater number of antihypertensive drugs to improve BP control, mainly because of a more stable BP control. Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other triple antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/Amlodipine/Indapamide is associated with more protective metabolic profile than any other considered combination antihypertensive medications.
本研究的目的是在一个特征明确的意大利队列中，比较评估不同三联组合抗高血压药物的长期临床、实验室和血流动力学效应。我们考虑了布里西盖拉心脏研究（BHS）参与者子集的数据，这些参与者在2012年至2020年期间的三次流行病学调查中接受了连续评估。对于当前分析，我们排除了血压正常的受试者、接受少于3种或不少于3种抗高血压药物治疗但未服用血管紧张素转换酶（ACE）抑制剂、血管紧张素II受体阻滞剂（ARB）、钙通道阻滞剂（CCB）和/或噻嗪类/噻嗪样利尿剂的患者。其余参与者根据他们是否接受培哚普利/氨氯地平/吲达帕胺、ACE抑制剂（除培哚普利外）/CCB/噻嗪类或ARB/CCB/噻嗪类治疗而分为三组，治疗方式为单独用药或固定复方制剂。另外选择一组年龄和性别匹配的志愿者作为对照，包括接受其他抗高血压治疗的患者。在预先定义的组间比较了不同抗高血压治疗的长期（12年）效果。在观察期内，所有研究亚组的收缩压和舒张压（BP）均有升高趋势（趋势P<0.05），但在接受培哚普利/氨氯地平/吲达帕胺治疗的亚组中，这种升高明显低于其他组（P<0.05）。与其他三联组合抗高血压药物相比，肾素-血管紧张素系统（RAS）调节剂、CCB和噻嗪类/噻嗪样利尿剂的联合治疗与显著更低的舒张压（P<0.05）和更严格控制的血脂谱相关。接受培哚普利/氨氯地平/吲达帕胺治疗的患者血清总胆固醇水平未出现任何与年龄相关的升高。此外，在随访期间，他们中没有人患2型糖尿病，也不需要更多的抗高血压药物来改善血压控制，主要是因为血压控制更稳定。基于我们的观察，RAS调节剂、氨氯地平和噻嗪类/噻嗪样利尿剂的联合治疗在降低舒张压方面比其他三联抗高血压药物更有效，并且对血脂有更好的影响。与任何其他考虑的联合抗高血压药物相比，培哚普利/氨氯地平/吲达帕胺具有更具保护性的代谢特征。
