Combination therapy in the treatment of hypertension

Guerrero-García, Carolina; Rubio-Guerra, Alberto Francisco

doi:10.7573/dic.212531

Cited by 140 publications

(111 citation statements)

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“…The hypertension treatment regimen in the current study showed that telmisartan and telmisartan-based combinations were the preferred choices of antihypertensive therapy in 64% of patients, followed by olmesartan and its combination in 11% of patients. These results were in concordance with Guerrero-García C et al who stated that in hypertensive diabetes patients, multiple drug therapy is necessary to achieve blood pressure targets [ 9 ]. Studies report the CV protection of metformin, as it reduces the risk factors of CV diseases, including lipids, overweight, and hypertension; thus, lowering the incidence of CVD [ 10 - 11 ].…”

Section: Discussionsupporting

confidence: 90%

Glimepiride and Metformin Combinations in Diabetes Comorbidities and Complications: Real-World Evidence

Sahay

Mittal

Gopal

et al. 2020

Cureus

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Objective To evaluate the usage of various strengths of glimepiride and metformin fixed-dose combinations in the management of type 2 diabetes mellitus (T2DM) patients with comorbidities and complications. Methods A retrospective, non-randomized, non-comparative, multi-centric real-world study included T2DM patients (age > 18 years) taking glimepiride and metformin fixed-dose combinations. Age, duration of diabetes, diabetes complications, comorbidities (hypertension and dyslipidemia), dosage frequency, and concomitant medications were analyzed from medical charts. Results A total of 4858 T2DM patients were included, with a mean age of 52.67 years and males being predominant in the study population (60.85%). The laboratory investigations showed a mean glycated hemoglobin (HbA1c) of 7.5, low-density lipoprotein (LDL) cholesterol of 104.81 ± 38.19 mg/dL, and serum creatinine of 0.88 ± 0.26 mg/dL. Around 2055 (42.30%) T2DM patients were hypertensive, and telmisartan alone and a telmisartan-based combination were the drugs of choice for hypertension management. Similarly, 1073 (22.08%) T2DM patients were having dyslipidemia and were primarily managed with rosuvastatin and its combination in 664 (62%) patients. Macrovascular complications were observed in 339 (6.97%) T2DM patients, among which coronary artery disease (CAD) had maximum prevalence, affecting 273 (5.61%) T2DM patients. Microvascular complications were 1010 (20.79%) T2DM patients, among which neuropathy had affected a maximum of 686 (14.12%) followed by retinopathy (2.34%) and nephropathy (1.81%). Among the available 11 strengths, the glimepiride 2 mg and metformin 500 mg combination were most widely prescribed in 1297 (26.69%), followed by glimepiride 1 mg and metformin 500 mg in 1193 (24.57%) patients, and the preferred dosage pattern was twice a daily in 2665 (54.85%) T2DM patients. An age-wise prescription analysis showed that glimepiride and metformin combinations were the preferred choice for the management of diabetes across all the age groups. Conclusion The real-world evidence in the Indian clinical setting indicates that glimepiride and metformin fixed-dose combinations are widely used in the management in T2DM patients with comorbidities like hypertension, dyslipidemia, and diabetes complications. Glimepiride and metformin fixed-dose combinations are suitable for early as well as long-standing diabetes.

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Section: Discussionsupporting

confidence: 90%

Glimepiride and Metformin Combinations in Diabetes Comorbidities and Complications: Real-World Evidence

Sahay

Mittal

Gopal

et al. 2020

Cureus

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“…In the last couple of decades, combinational therapy has emerged as a promising strategy for treating several diseases such as cancer [ 5 , 6 ], diabetes [ 7 ], AIDS [ 8 ], hypertension [ 9 ], autoimmune diseases [ 6 ], tuberculosis [ 10 ], infectious diseases [ 11 , 12 ] and even against the recent COVID-19 pandemic [ 13 ]. In context to drug-resistance, ‘drug cocktails’ could be a game-changer as they come with several benefits such as (1) a broadened antimicrobial spectrum, (2) the likelihood of developing drug resistance would reduce substantially as the chances of acquiring resistance towards a novel combination would be much lower, (3) it could be more efficacious against polymicrobial infections, (4) if the exercised drugs act synergistically, i.e., the combined effect of antimicrobial agents used is greater than the sum of their individual effects, it could provide even better pathogen clearance than the single drug alone and that too at a very low concentration, and (5) the lower concentration of antimicrobial agents could minimize the drug toxicity in the host [ 11 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Synergistic bactericidal profiling of prodigiosin extracted from Serratia marcescens in combination with antibiotics against pathogenic bacteria

Gohil

Bhattacharjee

Singh

2020

Microbial Pathogenesis

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The emergence of multidrug-resistant (MDR) bacteria is on the rise and the situation has been worsening with each passing day, which is evident from the outpouring number of reports about how more and more pathogens are becoming resistant to even the third and fourth generations of antibiotics. Lately, combination therapies or drug synergy have been giving promising results in curbing infections since it delineates its action on multiple aspects as compared to monotherapies. In this study, we used prodigiosin, a bacterial pigment endowed with magnificent biological properties, in combination with six antibiotics to study its effect on Pseudomonas aeruginosa , Staphylococcus aureus and Chromobacterium violaceum . Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of prodigiosin against the test organisms was determined and a checkerboard assay of prodigiosin with various antibiotic combinations was performed with an aim to abate antimicrobial resistance. MIC and MBC of prodigiosin was obtained in the range of 4–16 μg/mL, which was lower than that of most test antibiotics. Coupling prodigiosin with other test antibiotics exhibited an excellent synergy profile against all test organisms and the effects were reported to be either synergistic or additive. In the case of S. aureus and C. violaceum , all combinations were found to be synergic, and remarkably for S. aureus , FBC index was reported to be as low as ≤0.25 with all of the test antibiotics. Therefore, it is deduced that prodigiosin augments and intensifies the action of antibiotics, and results in a double-whammy against the MDR strains.

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“…[12] There is evidence that BP control is poor when using monotherapy and that a minimum of two agents is usually required to reach target BP in the majority of patients. [27]…”

Section: Introductionmentioning

confidence: 99%

Evaluation of blood pressure control and associated factors among patients with hypertension in Iraq: a prospective cross-sectional study

Nassr

Forsyth

2019

J Pharm Bioall Sci

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A bstract Background: Uncontrolled blood pressure (BP) is a major contributor to cardiovascular disease–related morbidity and mortality. However, evidence regarding the rate and factors associated with uncontrolled BP in Iraq is scarce. The objectives of this study were a) to assess the magnitude of and factors associated with patient BP control and b) to investigate the patient-level prescribing patterns of antihypertensive medications, in a large Iraqi hospital. Materials and Methods: A prospective, cross-sectional study was conducted in the primary care centers of Al-Yarmouk Hospital in Baghdad, Iraq, between April 2018 and August 2018. Eligible patients answered standard survey questions and had their BP measured. Controlled BP was defined as <130/80mm Hg for patients with diabetes and/or chronic kidney disease and <140/90mm Hg for other populations. Results: During the study period, 300 patients were included; of which, 67.3% were female. The average age was 57.6 (9.2) years (range, 25–79 years). Among the 300 patients included, only 38.7% had controlled BP. In univariate analysis, poorly controlled BP was not associated with education, employment, smoking, comorbid conditions excluding diabetes, and therapeutic regimen used. In contrast, the strongest predictors of uncontrolled BP were age <60 years, male sex, and diabetes mellitus. The majority were prescribed monotherapy (53.0%), followed by dual therapy (38.7%), and triple therapy (8.3%). Angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors were the most commonly prescribed medications at 74.7%, followed by beta-blockers at 29.3%, calcium channel blockers at 28.0%, and diuretics at 23.0%. Conclusion: BP control was suboptimal. Effective feasible strategies should be implemented to increase BP control in Iraq to reduce hypertension-related complications.

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Combination therapy in the treatment of hypertension

Cited by 140 publications

References 50 publications

Glimepiride and Metformin Combinations in Diabetes Comorbidities and Complications: Real-World Evidence

Glimepiride and Metformin Combinations in Diabetes Comorbidities and Complications: Real-World Evidence

Synergistic bactericidal profiling of prodigiosin extracted from Serratia marcescens in combination with antibiotics against pathogenic bacteria

Evaluation of blood pressure control and associated factors among patients with hypertension in Iraq: a prospective cross-sectional study

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