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Current status of combination therapy in other cardiovascular-diseases

(1995) JOURNAL OF HUMAN HYPERTENSION. 9(Suppl. 4). p.S41-S45
Author
Organization
Abstract
As in hypertension, the addition of a second active drug is believed to enhance treatment efficacy; however, the extent to which a combination of two low-dose drugs outperforms conventional monotherapy remains uncertain. Established treatments of angina comprises nitrates compounds, beta-blockers and calcium antagonists, which are often given in combination. Beta-blockers are major players in this field as they inhibit the tachycardia induced by nitrates and calcium antagonists; there is therefore a pathophysiological justification for their use in combination therapy, supported by repeated confirmation of positive clinical effect. The most widely chosen calcium antagonists are dihydropyridines; verapamil may impair conduction. However, it is not clear whether combination enhances the effects of the individual antianginal substances. Diuretics are for most clinicians the keystone treatment of heart failure; diuretics are often combined with other drugs, e.g. amiloride and spironolactone. The latter also have a beneficial effect on myocardial structure (myocardium/collagen ratio). ACE-inhibitors are of proven clinical efficacy, and, in addition, have a beneficial effect on survival. They combine well with diuretics: because the diuretic stimulates renin release, the ACE-inhibitor can be given at a lower dose (enhancement of effect). There are, however, certain drawbacks (hypotension, hyperkalemia with antialdosterones). The results of combining ACE-inhibitors with calcium antagonists and beta-blockers await investigation. The ISIS studies demonstrated the advantages of combining beta-blockers, thrombolysis and aspirin in acute infarction. ACE-inhibitors have recently been added to the regimen with a positive effect (extended survival), especially in the presence of a decreased ejection fraction (SAVE, AIRE, GISSI 3 and ISIS 4 studies). However, as in angina, an enhancement effect has not yet been conclusively demonstrated. To prove this last point, studies are mandatory, but they will be difficult, costly and require a large number of patients.
Keywords
STABLE ANGINA PECTORIS, MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE, COMBINATION THERAPY

Citation

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Chicago
Clement, Denis, MC Wimart, and E Thibout. 1995. “Current Status of Combination Therapy in Other Cardiovascular-diseases.” Journal of Human Hypertension 9 (Suppl. 4): S41–S45.
APA
Clement, D., Wimart, M., & Thibout, E. (1995). Current status of combination therapy in other cardiovascular-diseases. JOURNAL OF HUMAN HYPERTENSION, 9(Suppl. 4), S41–S45.
Vancouver
1.
Clement D, Wimart M, Thibout E. Current status of combination therapy in other cardiovascular-diseases. JOURNAL OF HUMAN HYPERTENSION. 1995;9(Suppl. 4):S41–S45.
MLA
Clement, Denis, MC Wimart, and E Thibout. “Current Status of Combination Therapy in Other Cardiovascular-diseases.” JOURNAL OF HUMAN HYPERTENSION 9.Suppl. 4 (1995): S41–S45. Print.
@article{194976,
  abstract     = {As in hypertension, the addition of a second active drug is believed to enhance treatment efficacy; however, the extent to which a combination of two low-dose drugs outperforms conventional monotherapy remains uncertain. Established treatments of angina comprises nitrates compounds, beta-blockers and calcium antagonists, which are often given in combination. Beta-blockers are major players in this field as they inhibit the tachycardia induced by nitrates and calcium antagonists; there is therefore a pathophysiological justification for their use in combination therapy, supported by repeated confirmation of positive clinical effect. The most widely chosen calcium antagonists are dihydropyridines; verapamil may impair conduction. However, it is not clear whether combination enhances the effects of the individual antianginal substances. Diuretics are for most clinicians the keystone treatment of heart failure; diuretics are often combined with other drugs, e.g. amiloride and spironolactone. The latter also have a beneficial effect on myocardial structure (myocardium/collagen ratio). ACE-inhibitors are of proven clinical efficacy, and, in addition, have a beneficial effect on survival. They combine well with diuretics: because the diuretic stimulates renin release, the ACE-inhibitor can be given at a lower dose (enhancement of effect). There are, however, certain drawbacks (hypotension, hyperkalemia with antialdosterones). The results of combining ACE-inhibitors with calcium antagonists and beta-blockers await investigation. The ISIS studies demonstrated the advantages of combining beta-blockers, thrombolysis and aspirin in acute infarction. ACE-inhibitors have recently been added to the regimen with a positive effect (extended survival), especially in the presence of a decreased ejection fraction (SAVE, AIRE, GISSI 3 and ISIS 4 studies). However, as in angina, an enhancement effect has not yet been conclusively demonstrated. To prove this last point, studies are mandatory, but they will be difficult, costly and require a large number of patients.},
  author       = {Clement, Denis and Wimart, MC and Thibout, E},
  issn         = {0950-9240},
  journal      = {JOURNAL OF HUMAN HYPERTENSION},
  language     = {eng},
  number       = {Suppl. 4},
  pages        = {S41--S45},
  title        = {Current status of combination therapy in other cardiovascular-diseases},
  volume       = {9},
  year         = {1995},
}