ROLE/efficacy of RAMIPRIL COMPARING With Amlodipine in hypertension in reducing mortality

This systematic review focuses on the long-term effect of Amlodipine and Ramipril in treating hypertension in cardiovascular patients to reduce mortality rate. It analyzes the impact of Amlodipine on blood pressure and patient outcomes, the effectiveness of Ramipril in treating hypertensive patients, and the effectiveness of fixed dose combination therapy in reducing hypertension-related risks.

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Table of Contents
ABSTRACT.....................................................................................................................................1
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................2
Methods and results................................................................................................................2
SYSTEMATIC REVIEW (Discussion)...........................................................................................5
Theme 1: Impact of first-line agent Amlodipine with efficacy for improving blood pressure
and patient outcomes..............................................................................................................5
Theme 2: Effectiveness of using Ramipril in treating hypersensitive patients......................6
Theme 3: Effectiveness of fixed dose combination therapy in reducing down the risk related
to hypertension.......................................................................................................................8
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................11

Topic: ROLE/efficacy of RAMIPRIL COMPARING With Amlodipine in hypertension in
reducing mortality.
ABSTRACT
Hypertensive patients who are also suffering from coronary artery disease are at high risk of
suffering from heart stroke. Thus, it can reduce down the health outcome of patient and risk of
mortality among them is also been increased. This systematic review will lay emphasis on the
long term effect of Amlodipine and Rampiril in treating hypertension in cardio-vascular patients
so that rate related to mortality can also be reduced down. Research into the treatment of
hypertension has produced a multitude of drug classes with different efficacy profiles. There are
also various key words that have been used in order to make the research successful. It includes
hypertension, coronary heart disease, blood pressure, hypertension, heart failure. These
keywords have made the search easy and also the scholar was been able to evaluate the relevant
articles related to subject matter. It also shows effectiveness of Ramipril drug in reducing
hypertension which may cause severe cardiovascular disease in patients and also can increase
mortality rate. Further, it shows reasons of using fixed dose combination therapy in treating
people with hypertension or giving effective combined drugs because it reduces side effects as
compare to those drugs given in mono therapy by increasing dosage. This present study aims at
showing systematic reviews on effectiveness of Amlodipine drugs and knowing that how it
affects people and make them able to proper functioning of heart and it can be known by
comparing its effectiveness and ingredients used in this drug to Ramipril drug. Hypertension is
increasing day by day and around 1 billion people worldwide is suffering from it and if it is not
being treated in a timely manner then it leads to severe cardiovascular disease so, combination
fixed dose therapy is recommended by doctors for recuing mortality rate.
INTRODUCTION
Hypertension is well established as a major risk factor for cardiovascular disease. Although
there is undeniable evidence to support the beneficial effects of antihypertensive therapy on
morbidity and mortality, adequate blood pressure management still remains suboptimal. Various
medications can be given in order to treat the hypertension so that patient risk related to
developing cardio vascular disease reduces. It has also been analysed that there are factors
because of which an individual can go through hypertension. Obese person are at more risk of
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getting hypertension and problem related to heart. It has also been analysed that individuals who
are involved in consuming higher amount of salt can also suffer from the problem of
hypertension. Consuming high amount of liquor and smoking cigars regularly can also increase
patients risk of developing problem related to hypertension. People who are not physically active
can also develop the problem of hypertension because of which they are at high risk of
developing problems related to heart. Various drugs are been made so that the mortality rate can
be reduced and also the health outcome of patient can also be improved. Rampiril can be given to
patient in order to treat hypertension. There is a lot of evidence which has supported the
management of blood pressure by taking anti-hypersensitive therapy or drugs. It has also been
analysed that mild to moderate hypertension has been cured by making use of Rampiril. It has
enhance the health outcome of patient who have been suffering from this disease. It has also
been analysed that Amlodipine can also be used in order to treat patient going through
hypertension and who are at high risk of developing cardio vascular disease. This drug has also
improved health outcome of patient. Rampiril is a drug that is used for treatment of high blood
pressure and through use of Rampiril, strokes, heart attacks and kidney problems can be
prevented. Amlodipine is a drug that is also known as calcium channel blockers. Amlodipine
works by relaxing blood vessels so that flow of blood gets easy and this is also used to preven
certain type of chest pain.
Aim: To analyse the ROLE of RAMIPRIL COMPARING with Amlodipine in hypertension in
reducing mortality.
Research Questions:
 What is the impact of first-line agent Amlodipine with efficacy for improving blood
pressure and patient outcomes?
 What is the effectiveness of using Ramipiril in treating hypersensitive patients?
 What is the effectiveness of fixed dose combination therapy in reducing down the risk
related to hypertension?
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MAIN BODY
Methods and results
Calcium channel Blockers was been introduced around 35 years ago. These blockers were
initially been made to cure coronary heart disease, bit later it was been found effective for
treating hypertension suffering from any cardio vascular disease so that mortality rate can also be
reduced down. Amlodipine has so many other unique qualities which makes then more effective
for treating down the HTN. This review has laid emphasis on comparing Amlodipine with other
agents in the class such as Rampiril. It has also laid focus on reducing down the rate of mortality
by treating hypertension.
Methods:
The systematic review profile will lay focus on Amlodipine and Rampiril. It will lay
emphasis on analysing their role for treating hypertension so that mortality rate can be reduced.
These drugs now have been used for more than 2 Decades (Kawalec and et.al.,2018). A
systematic review has been done of PUB-MED, Web of science. Response to antihypertensive
treatment was evaluated by using a blood pressure target of <140/90 mmHg in all patients,
irrespective of the presence of diabetes, and <150/90 mmHg, as recommended for older
hypertensive. Amlodipine is a long action calcium chain blocker that is really effective in
treating hypertension. Systematic search strategy was also being used to have article related to
subject matter. It was being analysed that only articles which were been published in English
language was been selected for study. It was also being evaluated that no older articles were been
selected. The article was being selected from between 2016-2020. It was also being analysed that
the information related to conducting systematic review on subject matter was been taken from
the authentic and reliable websites. The article also follows the inclusion and exclusion criteria
(Vögele and et.al.,2017). It was being analysed that key words which was been included to
conduct the study includes, cardiovascular, coronary heart disease, angina, Amlodipine, effects.
The other key words which is not been related to subject matter was not been included in study.
Data base search and quality assessment of the topic was also being done for study. It has also
been analysed that this has made the study more authentic as well as relevant. It has also helped
the scholar in making study successful. It was also being analysed that articles which were been
published in any other language was not been used for the study.
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It has also been evaluated that this drug is been given for the treatment of hypertension as
well as angina. Mostly the people who have been suffering from hypertension are of older age
and they are also at more risk of developing cardio vascular problem. The Dosage related to
Amlodipine is been given once on daily basis, so that health outcome of patient can be improved
and also they do not face any risk related to cardio vascular problems. It has also been analysed
that a starting dosage of 5 Mg is mostly recognised to patients who are suffering from
hypertension. In the older age patients who are at more risk of hepatic failure. They can also be
provided with 2.5 mg and that too regularly. These are basically being given by health care
professional so that the risk related to cardio vascular problems can be reduced down and also
mortality rate can be cut down.
Most of the people all around the world dies because of the heart stroke and one of the
major reason of facing heart related problem is hypertension. It is also reason of increasing
mortality rate. There are also various side effects of Amlodipine. The adverse effect related to
the drug or medication can be minimised when it is being given during the bed time. There are
various side effects which can be faced by patient such as dizziness, fatigue, nausea, vomiting.
This can lay huge negative impact on health outcome of patient. Their wellbeing and quality of
life can also be hampered. This medication is also being contradicted for usage of breast feeding
women and also with the patient who have unstable angina. The comparison of Amlodipine
versus Rampiril has also been done. Randomised trial was being enrolled in order to evaluate and
analyse the subject matter. Amlodipine 10 mg and Rampiril 20 mg was been used to conduct the
trial. On this study a systematic review was been done. It was being analysed that patient who
was been given Amlodipine, there occurs a less rate of hospitalisation in comparison to other
drugs which has been provided to patients. There are also that patients who are allergic to these
drugs must not been involved in consuming it, as it can cause so many other side effects and
problems which can reduce down the health outcome of patient. It has also been analysed that
Amlodipine significantly reduced non-fatal myocardial infarction and chances of getting a stroke
by 26% (Pisano and et.al.,2020). This can reduce down the mortality rate which has been
increased because of consuming drugs like Amlodipine. This study has also provided the results
that Amlodipine versus Rampiril there was a reduction in rate related to hospitalisation of
patients suffering from angina. This means that Amlodipine is effective in curing down the
problem of HNT. It has also shown out the reduced rate of event based on Cardio vascular and
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the rate of mortality has also been lowered down in comparison to using of Rampiril. It has also
been analysed and evaluated from the research that there are various other drugs which can also
be taken so that the health outcome of patient who have been suffering from hypertension
improves. Amlodipine also have the huge effect on left ventricle on person who is been suffering
from HTN. Thus it has been analysed from the trial that this medication can be given to patients
in order to treat mild to moderate hypertension. This trial was being done to analyse the effects
of both medications. It has also been evaluated that patients’ needs to have full information
related to medication that has been provided to them by health care professionals. Thus, it will
assist them in consuming correct dosage which is really necessary so that health outcome of
patient can be improved. It has also been analysed that cardio vascular disease has been lowered
down in patients who have been treated from Amlodipine. It has also been analysed that
traditionally CCB was not been used for treatment of HTN or discontinued. This was because
unfavourable results were being seen because of reflex stimulation. There were also randomised
trial which was been done on Amlodipine and Rampiril. It was being done to know about
effectiveness of these drugs on patients who are been suffering from hypertension and are at risk
of developing cardio vascular disease. It can also reduce the health outcome of patient and also
their quality of life can be reduced down. Although the studies performed so far are not entirely
homogenous for design, inclusion criteria, study duration, and endpoints, some similarities with
our results may be observed, at least for some studies. Combination therapy can also be given in
the treatment of HNT. The risk related to developing of cardio vascular disease can also be cut
down because of giving combination therapy patients. This will also help them in reducing rate
of mortality which has been increased because of development of hypertension. It has also been
analysed that are various signs and symptoms which can be seen in person who is at risk of
suffering from hypertension. They can face problems like loss in appetite, obesity.
SYSTEMATIC REVIEW (Discussion)
Theme 1: Impact of first-line agent Amlodipine with efficacy for improving blood pressure and
patient outcomes
In the context of Amlodipine, it can be sad that it is one of the effective drug or pill which
is being given to patients with cardiovascular disease and patients suffering from hypertension.
Hear related disease mainly happen or occur when blood do not circulate and heart does not
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pump blood. Blood pressure is the main reason of it and for treating patients with cardiovascular
disease it is important to provide treatment to eliminate root cause of the problem and Hence,
Amlodipine is being given to treat high blood pressure or reducing hypertension.
Figure 1: Efficacy of Amlodipine in blood pressure and patient outcome
Source: (Amlodipine in hypertension: a first-line agent with efficacy for improving blood
pressure and patient outcomes, 2016)
In the context of this pill or drug, Fares and et.al., (2016) stated that Amlodipine has good
efficacy as well as safety and it has been proved by successful trails on patients with
cardiovascular or hypertension in the event of cardiovascular reduction. It is also being
considered first line anti hypertensive agent as one of the main reasons behind it is it has a
gradual onset of action. It helps in preventing patients against negative or adverse effects on lipid
and carbohydrate which causes hypertension and blood pressure. Amlodipine is a long acting,
third generation dihydropyridine which exerts its action through inhibition of calcium influx into
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vascular smooth muscle cells and myocardial cells. These helps in reducing peripheral vascular
resistance. It is also important to consider and give the right amount of dose to patient as per the
intensity of their disease and age as well. In the context of normal and safe dose it is identified
that 5 mg is safe and recommended and with maximum daily dose as per the degree of disease in
adults it is given to 10mg. It is also found that if this drug is being discontinued then blood
pressure returns to baseline over 1 week even without any dangerous rebound elevations in BP.
According to the Hassan fares, Amlodipine in Hypertension: A First Line Agent with Efficacy
for Improving Blood Pressure and Patient Outcome, (2016) There is evidence which shows that
Amlodipine is first line agent and safe drug in preventing patients against hypertension in an
effective manner. It can be known from Fosinopril versus Amlodipine Cardiovascular Events
Randomized Trial. This trail shows different results on fasting glucose level. One of the main
aims of doing this trail is to know effectiveness of this drug as compare to others and Ramipril
on diabetes or lipid control in patients with hypertension. In this trail, around 380 patients were
being taken as sample and being given 10mg of Amlodipine and 20 mg of Fosinopril with follow
up period of around 3.5 years. Results which received after some years showed no difference on
lipid and Fosinopril is being considered having great effects on blood pressure control and if we
have other drugs which can have same effects like this then it can clearly be said that it has
effectiveness and can have several positive effects (Sharma and et.al., 2020).
Theme 2: Effectiveness of using Ramipril in treating hypersensitive patients
Ramipril is also known as Atlace which is one of the effective drugs used in reducing
hypertension or relaxing blood vessel which may cause cardiovascular disease. It is mainly being
given as like Amlodipine in lowering blood pressure as well as risk of stroke in older people.
Ramipril is a 2-aza-bicyclo acid derivative, white, crystalline substance soluble as it melts
between 105 degree to 112 degree. This structure of Ramipril is indication that it is being made
and used safe ingredients. It is important to reduce blood pressure as it reduces the risk of fatal as
well as non fatal cardiovascular events and it is also stated that in the UK mortality rate is
increasing majorly because of hypertension and blood pressure. For reducing this rate, doctors
are providing better treatment and prescribing Ramipril because of its effectiveness of treating
patients Borghi and et.al., (2018).
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In this context Benefits of Combination of Ramipril, Amlodipine in Hypertension, (2016)
stated that for reducing risk of high blood pressure and hypertension it is important to reduce risk
of stroke and myocardial infarction as it is one of the main causes of this problem. Ramipril is
known the best for sustaining acute myocardial infarction. Initiate dosing at 2.5 mg once daily
for 1 week, to a maintenance dose of 10 mg once daily. After giving dose of this drug patient are
being kept in observation at least 2 hours because it is expected hours of controlling blood
pressure. The effect of Ramipril on hypertension appears to result at least in part from inhibition
of both tissue and circulating ACE activity. In addition, it is also found from the UK prospective
diabetes study that 80% of patients with type 2 diabetes mellitus have high blood pressure and it
is one of the main cause so, it is being found that Ramipril given to patients along with
Amlodipine and BP during follow-up was significantly reduced. One of the main effectiveness
and reasons which shows that how it works is combination of Ramipril with Amlodipine and
only Ramipril convert enzyme inhibitors as well as calcium chain blockers which increases
vascular resistance and this process has been a used in the antihypertensive therapy for many
years which is reducing mortality as well as hospitalization rate in the UK because of
hypertension and blood pressure.
In addition, it is also found that antihypertensive effects of single dose of this Ramipril
lasts only for 24 hours. Main impacts on body can be seen after 3-4 weeks. For better results,
sometimes patients have to take treatment or dosage of this drug for around 2 years.
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Figure 2: Effectiveness of Ramipril
Sources: (Effects of Ramipril, Telmisartan on Left Ventricular Hypertrophy in Individuals at
High Vascular Risk, 2012)
On the basis of above data, it can clearly be said that patients who took Ramipril as
compared to other drugs, were more likely to treat in a better manner. It is effective in decreasing
negative impacts or prevalence of left ventricular hypertrophy.
According to the Guerrero-García and Rubio-Guerra, (2018) stated that Ramipril not only
helps patients in treating them against hypertension in present but also it prevents them against
future stroke, heart attacks. In this context it is also found that if patents take it regularly after
heart attack as per the prescription then it can improve their health and increase survival rate
which directly leads in reduction of mortality rate. In this context they also stated that Ramipril
reduced diastolic blood pressure equals to 90mmhg by giving at least 10mmhg in around 84.1%
of patients. It works on Angiotensin-converting enzyme inhibitors which are mainly important in
relaxing veins and arteries to lower blood pressure of people. In patients with high blood
pressure this inhibitor prevents enzyme in their body from producing Angiotensin II which is the
main cause of narrowing blood vessels and lead hypertension due to high blood pressure. So,
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overall it can be said that from functioning of Ramipril that it is an effective drug which can
definitely help people in reducing hypertension and mortality rate as well.
Theme 3: Effectiveness of fixed dose combination therapy in reducing down the risk related to
hypertension
It is identified that Ramipril and Amlodipine drugs work effectively when given individually in
treating patients with hypertension but for more improvements and treating patients quickly
some doctors give combination therapy or more than 1 drug in treating hypertension. Fixed dose
combination therapy of drugs has better effects on blood pressure than free equivalent
combination. According to the Effectiveness of Fixed Dose Combination Therapy in
Hypertension, (2018). In this systematic review and in one study around 301 abstracts screened
in which 3 studies were narrative review in order to find out effectiveness of fixed dose
combination therapy in preventing patients against hypertension as compared to free equivalent
combination. Around 1 billion people are suffering from hypertension worldwide and it is the
main reason of increased mortality and hospitalization rate which also affecting overall healthy
and quality of lives of societies. So, it is important to think about this and providing better and
safe therapies and treatments and that is why this fixed doze combination therapy is being trailed
on some people.
Improper management of hypertension leads to cardiovascular disease and in fixed dose
combination therapy effect sizes are being calculated throughout separate meta-analyses
stratified average medicine possession ratio. One of the main reasons of providing fixed dose
combination therapy is allowing patients to get adequate control on blood pressure by making
fixed dose of combination therapy as it also helps them out in minimizing risks (Radchenko,
Mushtenko and Sirenko, 2018). When patients find problems in making control on blood
pressure while taking mono-therapy then in such situations, dosage of drugs are being increased
which may treat patients but after few days it may have adverse effects so, for reducing adverse
and side effects rather than increasing dosage of mono-therapy, dosage is being kept fixed in
combination therapy. Combination of therapy of fixed dose allows for action on several different
hypertensive mechanisms. In this therapy, doctors make use of 2 drugs such as Ramipril and
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Amlodipine and others with different mechanism of actions. It is stated that such therapies have
2-5 times antihypertensive effect greater than obtained by mono-therapy without causing side
effects. But there are only few medicines or drugs which may be combined for giving this fixed
dose combination therapy as there are some drugs which cannot be combined with other drugs as
it may have some adverse effects. So, it is important to take therapies in a prescribed manner for
improving overall health and reducing mortality rate (Basile and et.al., 2020).
Results:
In comparison with Rampiril, Amlodipine is more effective in enhancing health outcome
of patient suffering from hypertension and reducing down the rate of mortality. It has also been
analysed that Amlodipine significantly reduced non-fatal myocardial infarction and chances of
getting a stroke. This can reduce down the mortality rate which has been increased because of
consuming drugs like Amlodipine (Jeffers, Robbins and Bhambri, 2017). It has also been
analysed that there was low hospitalisation rate when patient was being given with dosage of
Amlodipine on regular basis. It was also being analysed that there are so many side effects of
these medications that can lay severe impact on health outcome of patient. Most of the people all
around the world dies because of the heart stroke and one of the major reason of facing heart
related problem is hypertension. It is also reason of increasing mortality rate. It has been
analysed that for treatment of hypertension is more effective medication is Amlodipine. It has
also been analysed from the research that these medications can cause side effects like nausea,
vomiting and allergic reactions can also be caused when patients are being engaged in
consuming these medications. So in order to enhance health outcome it is really necessary that
patients are been involved in taking medications as prescribed by health care professionals. Thus
it has been analysed from the trial that this medication can be given to patients in order to treat
mild to moderate hypertension. It has also been analysed that rate of hospitalisation for treatment
related to cardio vascular problems has also been reduced when patient is being engaged in
taking this drug. It has also been analysed that this has also reduced mortality rate.
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CONCLUSION
From the above study it has been summarized that treating patients with hypertension and
reducing blood pressure Ramipril and Amlodipine drugs played a vital role. It has also been
discussed that as compare to Ramipril, Amlodipine drug has more efficacy and has greater
[positive and safe effects in treating patients with hypertension as well as reducing mortality rate.
One of the main reasons which this study and literature has discussed is Amlodipine it reduces
fatal as well as non fatal myocardial infraction which is the main cause of hypertension. It is
important to reduce mortality as well as hospitalization rate and it can be possible when patients
with high blood pressure are being treated effectively at initial stage with appropriate drugs
which do not cause them side effects and combination of Ramipril with Amlodipine has been
used in this which are reducing hospitalization rate of patients and patients are being treated at
initial stage. When patients take these both drugs on regular basis under prescription and proper
guidance then they are more likely to treated and become healthy.
Further, this study has discussed some side effects of taking over and high dose of Ramipril
as well as Amlodipine including: nausea, allergic reaction, vomiting and others so, it is stated
that patients should take these drugs and dosage after prescription otherwise it may cause severe
problems. Several trials have also been done in order to know effectiveness of Amlodipine as
compare to Ramipril and in all trails with patients of hypertension it is found that Amlodipine is
better than Ramipril and helps in reducing or treating mild to moderate hypertension. From these
trials which have been discussed in above study it has also been analysed that by giving
Amlodipine drugs and also Ramipril with Amlodipine has decreased hospitalization and
mortality rate in the UK. It is also improving overall health of people and quality of living of
them which is important for performing functions as well as improving economy. Lastly, it has
shown importance of using systematic review on specific topic as it allows researcher in
knowing actual data or results in number by which it becomes easier to accomplish objectives.
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myocardial infarction and heart failure: a review of the published and unpublished data
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ONLINE
Amlodipine in Hypertension: A First Line Agent with Efficacy for Improving Blood Pressure and
Patient Outcome. 2016. Online Available through: <
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051471/>
Benefits of Combination of Ramipril, Amlodipine in Hypertension 2016. Online Available
through: < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878169/>
Effectiveness of Fixed Dose Combination Therapy in Hypertension. 2018. Online Available
through: < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111352/>
Effects of Ramipril, Telmisartan on Left Ventricular Hypertrophy in Individuals at High
Vascular Risk. 2012. Online Available through: <
https://www.ahajournals.org/doi/full/10.1161/circulationaha.109.865774>
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