Amlodipine, Olmesartan Medoxomil

Attento® is a combined antihypertensive drug, which contains an angiotensin II receptor antagonist (ARA II) - olmesartan medoxomil and a blocker of "slow" calcium channels (BMCC) - amlodipine. The combination of the two active ingredients has a synergistic antihypertensive effect, as a result of which blood pressure (BP) decreases to a greater extent than when each of them is taken separately.

In an 8-week, double-blind, randomized, placebo-controlled study involving 1940 patients, it was shown that the antihypertensive effect of Attento® develops, as a rule, during the first 2 weeks of therapy. As shown in three studies, when using the drug once a day, the antihypertensive effect of Attento® persists for 24 hours, while the residual / peak ratio for systolic blood pressure (SBP) and diastolic blood pressure (DBP) ranged from 71% to 82% ... The antihypertensive effect was confirmed by outpatient blood pressure monitoring and did not depend on age and gender, as well as on the presence of diabetes mellitus in patients. In two open, non-randomized, extended studies, the sustained efficacy of Attento® 5 mg + 40 mg was shown in 49-67% of patients within one year of use.

In a double-blind, randomized, placebo-controlled study, the addition of amlodipine at a dose of 5 mg with insufficient efficacy of the previous (within 8 weeks) monotherapy with olmesartan medoxomil at a dose of 20 mg led after 8 weeks to a decrease in SBP and DBP by 16.2 and 10.6 mm Hg ... Art. (p = 0.0006), respectively. The proportion of patients who achieved target BP values ​​(<140/90 mm Hg for patients without diabetes mellitus and <130/80 mm Hg for patients with diabetes mellitus) was 44.5% with combination therapy olmesartan medoxomil at a dose of 20 mg and amlodipine at a dose of 5 mg, compared with 28.5% with olmesartan medoxomil 20 mg monotherapy.

In another study, the addition of 20 mg (40 mg) of olmesartan medoxomil with insufficient effectiveness of the previous monotherapy with amlodipine at a dose of 5 mg (within 8 weeks) led after 8 weeks to a decrease in SBP and DBP by 15.3 and 9.3 mm Hg. Art., respectively (the addition of 40 mg of olmesartan medoxomil - by 16.7 and 9.5 mm Hg. Art.). In patients who continued to receive monotherapy with amlodipine at a dose of 5 mg, SBP and DBP after 8 weeks decreased by 9.9 and 5.7 mm Hg. Art. respectively.

The proportion of patients who achieved target BP values ​​(<140/90 mm Hg for patients without diabetes mellitus and <130/80 mm Hg for patients with diabetes mellitus) was 29.9% in the monotherapy group amlodipine at a dose of 5 mg, 53.5% in the Attento® group at a dosage of 5 mg + 20 mg and 50.5% in the Attento® group at a dosage of 5 mg + 40 mg.

In an 8-week, double-blind, randomized, placebo-controlled study involving 1940 patients (71% Caucasian and 29% other races), the use of Attento® (with any combination of doses of its components) led to a significantly more pronounced decrease in SBP and DBP versus monotherapy. The degree of decrease in SBP / DBP depended on the doses of amlodipine / olmesartan medoxomil used: -24 / -14 mm Hg. Art. (5 mg + 20 mg), -25 / -16 mm Hg. Art. (5 mg + 40 mg) and -30 / -19 mm. rt. Art. (10 mg + 40 mg).

When using Attento® at a dosage of 5 mg + 40 mg, an additional decrease in SBP / DBP in the sitting position by 2.5 / 1.7 mm Hg was noted. Art. compared with the use of Attento® at a dosage of 5 mg + 20 mg. Similarly, the use of Attento® at a dosage of 10 mg + 40 mg led to an additional decrease in SBP / DBP in the sitting position by 4.7 / 3.5 mm Hg. Art. in comparison with the use of Attento® at a dosage of 5 mg + 40 mg. The proportion of patients who managed to achieve target BP values ​​(<140/90 mm Hg for patients without diabetes mellitus and <130/80 mm Hg for patients with diabetes mellitus) was 42.5%, 51. 0% and 49.1% for Attento® preparations at a dosage of 5 mg + 20 mg, 5 mg + 40 mg and 10 mg + 40 mg, respectively.

Olmesartan medoxomil, which is part of Attento®, is a potent specific ARA II (type AT1). Angiotensin II is the primary vasoactive component of the renin-angiotensin-aldosterone system and plays a significant role in the pathophysiology of hypertension by acting on AT1 receptors. Olmesartan, by preventing the binding of angiotensin II to AT1 receptors in tissues (including vascular and adrenal smooth muscles), blocks its vasoconstrictor effect, as well as the effects associated with the effect of angiotensin II on aldosterone secretion. The specific antagonism of olmesartan in relation to AT1-receptors leads to an increase in the activity of renin, angiotensin I and II in the blood plasma, and also contributes to a decrease in the plasma concentration of aldosterone.

With arterial hypertension, olmesartan medoxomil causes a dose-dependent long-term decrease in blood pressure.