MEDIX, God. 22 Br. 119/120  •  Sponzorirani članak  •  Kardiologija HR ENG

Lipitenzija – novi terapijski pristup?Lipitension – a new therapeutic approach?

Jasmina Ćatić

Budući da povišeni krvni tlak i dislipidemija često koegzistiraju (lipitenzija), to multiplicira kardiovaskularni rizik (npr. povišeni krvni tlak udvostručuje kardiovaskularni rizik, povišeni kolesterol u krvi ga utrostručuje, kombinirani učinak uzrokuje šest puta veći kardiovaskularni rizik). Stoga je kombinirano liječenje u svrhu sniženja krvnoga tlaka i poboljšanja lipidnog profila logičan pristup. Najbolji trenutno dostupni dokazi iz kliničkih ispitivanja i smjernice, podržavaju rutinsku primjenu takva pristupa i preporučuju rutinsku uporabu statina u većine hipertenzivnih bolesnika. Neki podatci pokazuju da specifične kombinacije antihipertenziva i statini mogu interakcijom generirati povoljne kardiovaskularne ishode. Kao što je preporučeno u NICE smjernicama 2011. godine i na temelju najboljih trenutno dostupnih dokaza, čini se vjerojatnim da će u bolesnika s hipertenzijom rutinska primjena kombinacije lijeka „A“ (ACE inhibitor ili ARB) i „C“ (blokator kalcijskih kanala) zajedno sa statinom (npr. atorvastatin), dovesti do znatnog smanjenja kardiovaskularnog tereta uzrokovanog povišenim krvnim tlakom. Ta bi kombinacija, čini se, trebala biti kamen temeljac standardnog liječenja hipertenzije. Čak i ako nema sinergije, ispitivanje ASCOT jasno pokazuje velike pozitivne učinke na svim razinama kardiovaskularnih ishoda vezane uz uporabu amlodipina i perindoprila s atorvastatinom.

Ključne riječi:
amlodipin/perindopril/atorvastatin; hipertenzija; dislipidemija; kombinirano liječenje

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 22 Br. 119/120

Since hypertension and dyslipidemia frequently coexist as lipitension, the risk of cardiovascular diseases is multiplied. Hypertension doubles the cardiovascular risk, high blood cholesterol triples the risk, while the combined effect of these two factors is a six times greater risk of cardiovascular diseases. Thus, a combination treatment reducing blood pressure and improving the lipid profile is a logical approach. The best currently available evidence from clinical trials and guidelines supports the routine use of this approach and recommends the routine use of statins in the majority of hypertensive patients. Some data indicate that a specific combination of statins and antihypertensive drugs can generate interaction beneficial to cardiovascular outcomes. As recommended in the NICE guidelines 2011 and based on the best currently available evidence, it seems likely that in patients with hypertension the routine use of combination of drugs „A“ (ACE inhibitor or ARB) and „C“ (calcium channel blocker), along with a statin administration (e.g. atorvastatin), would result in a significant reduction in cardiovascular burden caused by hypertension. It seems that this therapeutic combination should become a cornerstone of the standard treatment of hypertension. Even if there was no synergy, the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) has clearly demonstrated significant positive effects associated with administration of amlodipine and perindopril with atorvastatin at all levels of cardiovascular outcomes.

Key words:
amlodipine/perindopril/atorvastatin; hypertension; dyslipidemia; combined treatment