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Triplixam is a fixed dose combination of three well known antihypertensive agents, with complementary activities, to control blood pressure in patients with arterial hypertension: perindopril, an angiotensin converting enzyme inhibitor, indapamide, a diuretic whith thiazide-like effects but also specific properties, and amlodipine, a long-acting calcium antagonist of the dihydropyridine family. The potential synergic action allows better control of blood pressure with once daily administration, while limiting the incidence of adverse events. Various presentations with different dosages are available to facilitate individualized therapy. Warnings and precautions for use of every molecule should of course be respected. Such a fixed dose combination should contribute to limit clinical inertia and to improve therapeutic compliance.

Background: Calcium inhibitors are recommended as first-line treatment in hypertension. We report the development of telangiectasia on the trunk and upper limbs in a female patient on amlodipine (Amlor(®)) that subsided on treatment discontinuation., Patients and Methods: A 63-year-old woman consulted for numerous asymptomatic stellate telangiectasias on her upper trunk and shoulders, with sparing of the face. No Darier's sign was seen and clinical examination was otherwise normal. The patient had been treated with amlodipine (Amlor(®)) and a combination of bisoprolol and hydrochlorothiazide (Lodoz(®)) for 5years for essential hypertension. Laboratory tests, which included serum tryptase assay, were normal. Histological analysis showed a normal epidermis with dilated superficial dermal capillaries and no inflammatory infiltrate or dermal elastosis. Amlodipine was discontinued and replaced with ramipril (an ACE inhibitor). The other treatments were changed over and the telangiectasias regressed spontaneously within several months, with no relapse being seen at one year of follow-up., Comments: Reports of telangiectasia associated with calcium inhibitors most commonly involve the dihydropyridine family, of which amlodipine is a member. Inhibition of muscular contraction induced by this treatment results in vasodilatation, accounting for the associated antihypertensive properties, and this could play a role in telangiectasia formation. The literature contains reports of cases of photo-distributed telangiectasia, suggesting that as well as vasodilatation, calcium inhibitors may in certain cases cause abnormal sensitivity of blood vessels to ultraviolet radiation. The absence of facial lesions rules out the hypothesis of photo-induced lesions in our patient., (Published by Elsevier Masson SAS.)

Medically induced gingival overgrowth is one of the major side effects of phenytoine, cyclosporine A and the channel blocker Nifedipine and it is well documented in various studies and case series. Recently an alternative channel blocker, Amlodipine, has been implemented into the clinical treatment of cardiovascular diseases. By means of a clinical case presentation it was shown that Amlodipine is able to induce gingival overgrowth in the oral cavity as well. Additionally, the causes of Amlodipine-induced gingival hyperplasia are critically discussed and several options of therapy modalities presented.

83 patients were enrolled in a multicentre, randomized, open study to assess the efficacy of amlodipine in stable effort angina. Preselected patients were submitted to a one-week placebo wash-out period during which only nitrates or molsidomine were authorized. Patients were then randomized to receive either 5 mg of amlodipine as a morning dose, or 180 mg of diltiazem in three divided doses. After two weeks, the dosage was able to be increased (according to clinical efficacy) to 10 mg of amlodipine as a single dose or 240 mg of diltiazem in four divided doses. The antianginal efficacy of these two treatments was essentially evaluated in terms of the results of stress tests (ST) conducted at the end of the second week and fourth week of active treatment: and 24 hours after the last dose of the drug. The results of 63 patients who scrupulously complied with the protocol showed that amlodipine and diltiazem corrected or improved the ST parameters (time to onset and amplitude of ST depression, duration of ST, work performed). The anti-ischaemic action of amlodipine was maintained for at least 24 hours after the last dose and therefore provides better security (by covering the entire 24-hour period) and better compliance (by tolerating a dose omission of several hours).

A multicentre trial was undertaken in order to evaluate the therapeutic efficacy and ease of use of amlopidine in 1890 patients with stable effort angina. Involving prescribing conditions close to those of everyday practice, it revealed an improvement in angina symptomatology with one daily dose of amlopidine. After one month's treatment, 49.8% of patients were able to reduce or stop their use of fast-acting nitrites. After three months' treatment with amlopidine, 51% of patients had become asymptomatic. This study also revealed a decrease in the duration and severity of angina attacks. Safety/acceptability of amlopidine, assessed by clinical and laboratory parameters, was good, adverse events (22.7%), most often benign, improving or disappearing in more than half of all cases.