INFLUENCE OF COMBINATION ANTIHYPERTENSION THERAPY ON THE PARAMETERS OF VESSEL WALL RIGIDITY IN NON-CONTROLLED ARTERIAL HYPERTENSION PATIENTS WITH DEPRESSION

Aim. Assessment of combination of antihypertension therapy (CAT) including antidepressant, on the main parameters of ambulatory blood pressure monitoring (ABPM), vascular wall rigidity parameters and central aortic pressure in patients with non-controlled arterial hypertension (NCAH) and depression disorders (DD).Material and methods. Totally, 160 patients studied with NCAH and DD, whom CAT was prescribed, that included angiotensine converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. Patients were randomized to 2 groups: in 1 group, to the therapy antidepressant escitalopram (Es) was added 10 mg per day; in 2 group — calcium antagonist amlodipine 5-10 mg per day. At baseline and in 24 weeks all included patients underwent general clinical assessment, ABPM (hardware ABPM by LLC “Piotr Telegin” BPLab Vasotens, Russia) under circumstances of free exertion regimen, with measurements interval 25 min day and 50 minutes nighttime. The following was assessed: mean daily, daytime and nighttime systolic pressure (sBP), diastolic pressure (dBP), BP variability, time index of AH, level and speed of morning BP increase, circadian index, pulse BP. In addition, the mean daily parameters of vessel rigidity were evaluated: time of reflected wave spread, evaluative velocity of pulse wave in aorta, augmentation index (Alx, %); main central aortic pressure parameters were checked: sBP (sBPao, mmHg), dBP (dBPao, mmHg), mean pressure in aorta (BPaom, mmHg), augmentation index in aorta (Alxao, %). Questionnaires were completed by patients: anxiety and depression HADS, selfestimation of depression by Tsung, Spielberger anxiety, Vein vegetative changes, life quality questionnaire SF-36 and ABPM.Results. In 24 weeks of therapy the positive statistically significant dynamics of depression spectrum disorders was marked in Es group, but in the 2nd group, by the majority of parameters depression level remained high. Usage of antidepressant as a part of CAT led to significant decrease of anxiety and vegetative changes, but in “traditional” therapy group there was increase of anxiety and vegetative disorders remained. In 1st group of patients taking antidepressant there was more prominent and statistically significant comparing to control group improvement of life quality parameters by SF-36. CAT with Es led to decrease of BP to target levels in a half of patients in 4 weeks, but in controls, to reach target values, in 75,6% it was need to increase amlodipine dosage up to 10 mg daily. Comparison of dynamics of ABPM parameters in 24 weeks showed that in the 1st group there was significantly more prominent improvement of main ABPM parameters comparing to controls.Conclusion. Usage of Es in CAT led to significant improvement of psychoemotional and vegetative status of patients, decrease of the main symptoms of depression and anxiety, improvement of life quality parameters, more rapid target BP achievement and more significant improvement of main ABPM parameters, than therapy without antidepressant

Effectiveness of Chrono-Pharmacotherapy Depending on the Salt Sensitivity of Patients with Arterial Hypertension and Diabetes Mellitus Type 2

Aim. To study the effect of two regimens of combined antihypertensive therapy during the day on daily monitoring of arterial pressure, central aortic pressure, and arterial stiffness, depending on the salt sensitivity of hypertensive patients with diabetes mellitus type 2. Material and methods. 130 hypertensive patients with type 2 diabetes mellitus were included into the study. They were divided into 2 subgroups: salt-sensitive (group 1) and salt-resistant (group 2), and then randomized to subgroups A and B of ongoing therapy: in the morning ramipril and indapamide retard, bedtime – amlodipine (subgroup 1A and 2A); or in the morning amlodipine and indapamide retard, bedtime – ramipril (subgroup 1B and 2B). Initially and after 24 weeks of antihypertensive therapy, 24-hour blood pressure monitoring was performed, the indices of central aortic pressure and arterial stiffness were determined. Results. After 24 weeks, in all subgroups, there was a significant positive dynamics of the parameters of 24-hour blood pressure monitoring, central aortic pressure and arterial stiffness indices. In the subgroup 1В, it was registered a significant improvement in the majority of parameters of 24-hour blood pressure monitoring (decrease in 24-hours systolic BP by 24.4%, 24-hours diastolic BP by 22.1%; p<0.05), central aortic pressure (decrease in aortal systolic BP by 15.9%, aortal diastolic BP by 20.8%; p<0.05) and vascular wall stiffness parameters (decrease in pulse wave velocity by 13.8%; p<0.05) in comparison with group 1A (decrease in 24-hours systolic BP by 17.5%, 24-hours diastolic BP by 14.6%, aortal systolic BP by 12.7%, aortal diastolic BP by 9.7%, pulse wave velocity by 9.2%; p<0.05 in comparison with the group 1B). In the case of salt-resistant patients, there were comparable positive changes in the parameters of 24-hour blood pressure monitoring, central aortic pressure and arterial stiffness indices against the background of both dosing regimens during the day. Conclusion. In the study, it was demonstrated the more pronounced antihypertensive and vasoprotective efficacy of the combination of thiazide-like diuretic with calcium channel blocker in the morning and ACE inhibitor in bedtime compared to the alternative regimen of prescribed pharmacotherapy in salt-sensitive patients, and comparable efficacy of both regimens in salt-resistant hypertensive patients with diabetes mellitus type 2

Effectiveness of the original trimetazidine MR in patients with stable coronary heart disease and angina attacks resistant to trimetazidine generics (ETALON study)

Aim. To assess the clinical benefits of the original trimetazidine medication (Preductal® MR) in patients with stable coronary heart disease and angina attacks resistant to trimetazidine generics. Material and methods. The study included 112 patients with stable coronary heart disease (CHD), who experienced angina attacks, despite the treatment with trimetazidine generics added to the standard CHD therapy (antiaggregants, statins, β-аadrenoblockers, ACE inhibitors). All participants received Preductal® MR (35 mg twice a day) instead of trimetazidine generics. The follow-up duration was 3 months. Treatment effectiveness was assessed by the changes in angina attack incidence, short-acting nitrate consumption, and general status, using a visual analogue scale (VAS). In addition, pharmaco-economic analysis of the treatment effectiveness was performed. Results. The replacement of trimetazidine generics with Preductal® MR was associated with a reduction in angina attack incidence by 63 % and in the number of nitroglycerine tablets/doses by 65 % (p<0,01). VAS score increased from 45,3±13,8 to 71,6±11,9 (р<0,0001). Preductal® MR therapy is the best pharmaco-economic option, since the ratio between weekly treatment costs (RUB) and the weekly number of prevented angina attacks is minimal for this original medication. Conclusion. In patients with stable CHD and angina attacks, resistant to trimetazidine generics, Preductal® МR therapy is associated with a significant reduction in angina attack incidence and consumption of short-acting nitrates. Preductal® MR is the most cost-effective medication, providing optimal effectiveness with minimal costs

THE IMPACT OF COMBINATION ANTIHYPERTENSION THERAPY ON THE MAIN PARAMETERS OF STRUCTURAL AND FUNCTIONAL CONDITION OF THE LEFT VENTRICLE MYOCARDIUM IN NON-CONTROLLED ARTERIAL HYPERTENSION WITH DEPRESSION SPECTRUM DISORDER

Aim. To evaluate the influence of antihypertension therapy that includes antidepressants, on the main parameters of structural and functional condition of the left ventricle (LV) myocardium in patients with non- controlled arterial hypertension (NCAH) and depression-spectrum disorder (DD).Material and methods. Totally 160 patients included, with NCAH and DD, median age 58 (53-64) y.o., who were administered combination therapy that included angiotensin-converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. The patients were randomized into 2 groups: to the 1st group we added escitalopram (Selectra, Abbott Laboratories) as antidepressant, 10 mg/ day; to the 2nd group — calcium channel antagonist (CA) amlodipine 5-10 mg/day. All patients at the baseline and in 6 months underwent ambulatory blood pressure monitoring (ABPM), echocardiography, DD diagnostics with the Tsung and HADS scores.Results. After 4 weeks of treatment the therapy that included antidepressant led to the decrease of BP to target levels in 52,6% of patients, in CA — in 24,4%, and in 24 weeks of treatment there was comparable number of target reached patients in both groups. Comparative analysis of cardioprotection action of combination antihypertension therapy showed that in the usage oif antidepressant, as in CA usage there was comparable regression of hypertrophy and diastolic function of LV myocardium. With the treatment, in the 1st group there was increase of patients with normal geometry of the LV by 54,7%, and in the 2nd group — by 52,4% (p<0,05). In the 1 and 2 groups we saw the increase of those with normalized diastolic LV function: to 68,8% and to 65,1%, respectively (p<0,05).Conclusion. Addition of escitalopram as part of combination therapy mediated a significant antihypertensive effect, a little overcoming the treatment with amlodipine addition. Usage of tetracomponent therapy in combination of HADS and DD led to significant and comparable regression of structural and functional changes of the LV myocardium, that can be utilized for optimization of arterial hypertension control in this category of patients

FEATURES OF DIURNAL BLOOD PRESSURE PROFILE, ARTERIAL STIFFNESS AND CENTRAL AORTIC PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND PREDIABETES

Aim. To assess the features of diurnal blood pressure profile, arterial stiffness and central aortic pressure in patients with arterial hypertension (AH) and prediabetes.Materials and methods. The study included 118 patients with AH, 38 without prediabetes, 80 with prediabetes, 48 of them patients with impaired fasting glucose and 32 patients with impaired glucose tolerance. Prediabetes was determined by the results of an oral glucose tolerance test. All patients underwent 24-hour blood pressure monitoring the main parameters of arterial stiffness and central aortic pressure were determined using the BPLab Vasotens complex of OOO «Petr Telegin» (Russia).Results. The obtained data showed that in patients with hypertension and prediabetes there were recorded increased levels of systolic and pulsatile blood pressure in the brachial artery and aorta, a more pronounced "pressure load" was detected compared to patients without prediabetes. At night, the level of diastolic blood pressure in the brachial artery and aorta, the diastolic pressure time index was higher than in patients with AH without prediabetes. Pathological type of the "non-dipper" curve was detected 2.5 times more often in patients with AH and prediabetes. Moreover, the pulse wave velocity, the augmentation index in the brachial artery and aorta characterizing the stiffness of the vessel wall were significantly higher in hypertensive patients with prediabetes.Conclusion. Thereby, in patients with AH in combination with prediabetes, unlike patients without prediabetes, there were more pronounced changes in the parameters of the diurnal blood pressure profile, arterial stiffness and central aortic pressure including the pulse wave velocity, the augmentation index and pulsatile pressure which are known to be sensitive indicators of target organ damage and are associated with an increased risk of developing cardiovascular and cerebrovascular complications

Gender characteristics of lipid correction and anti-remodelling effects of various lipid-lowering therapies in patients with metabolic syndrome

The article tells about a comparative evaluation of lipid correction and remodeling effects of statin monotherapy and its fixed combination with ezetimibe on the left ventricular myocardium, intima-media thickness (IMT) and C-reactive protein (CRP) in men and women with metabolic syndrome (MS). The combination simvastatin + ezetimibe was more effective in women, resulting both in greater number of patients achieving the target level of LDL cholesterol, and the degree of positive change in lipid profile and IMT. Hypolipidemic and anti-inflammatory effects are comparable in men and women with MS who took simvastatin. Therapy with simvastatin or simvastatin + ezetimibe has a more marked anti-remodelling effect in women compared with men

GENDER SPECIFICS OF THE COMBINATION ANTIHYPERTENSION THERAPY EFFICACY IN PATIENTS WITH ARTERIAL HYPERTENSION AND ISCHEMIC HEART DISEASE

Aim. To evaluate gender specifics of the efficacy of combination antihypertensive therapy by zofenopril and valsartan by QD or BID schedule in patients with arterial (AH) and stable coronary heart disease (CHD).Material and methods. Totally 98 men and 100 women were included with AH and CHD, who were randomized into 6 groups according to their gender differences and type of the therapy taken: I and IV groups (women and men) – zofenopril 30 mg/day in the morning, II and V groups (women and men) – valsartan 160 mg in the morning, III and VI groups (men and women) – valsartan 80 BID. All patients took β-adrenoblocker metoprolol succinate and diuretic hydrochlorothiazide. Follow-up period was 24 weeks. At the baseline and in 24 weeks, also ambulatory blood pressure monitoring performed (ABPM).Results. In men zofenopril intake and valsartan BID led to the achievement of target blood pressure values in most of the patients, as significant increase of the main ABPM parameters and profile normalization in 70% and 66,7% patients, resp. In women there were more patients with target BP, more significant positive changes in ABPM with “dipper” profile in 78,8% cases in the group of BID valsartan.Conclusion. In AH and stable CHD maximum antihypertensive efficacy in men was shown with ACE inhibitor zofenopril and ARA valsartan BID, in women – in valsartan, especially two times per day

THE EFFECT OF COMBINED ANTIHYPERTENSIVE THERAPY ON THE BASIC PARAMETERS OF THE LEFT VENTRICLE MYOCARDIUM STRUCTURE AND FUNCTION IN WOMEN WITH METABOLIC SYNDROME AND HYPOTHYROIDISM

Aim. To study the effect of combined antihypertensive therapy on the basic parameters of the left ventricle (LV) myocardium structure and function in women with arterial hypertension (HT), metabolic syndrome (MS) and hypothyroidism. Material and methods. Women (n=196) with HT grade 2–3 and MS were included into the study. Standard clinical examination including an assessment of thyroid status, ambulatory blood pressure (BP) monitoring and echocardiography was performed at baseline and after 6 months. The patients were split into 3 groups: control (without hypothyroidism) with subclinical and manifested (symptomatic) hypothyroidism (SH and MH). Depending on baseline heart rate (HR) patients of each group received a combination of amlodipine+losartan (A+L) in HR &lt;85/min or a combination of amlodipine+moxonidine (A+M) in) in HR ≥85/min. Results. The significant antihypertensive effect was found in patients of the control group due to both A+L and A+M combination (target BP was reached in 85.7 and 88.2%, respectively). In patients with hypothyroidism significant antihypertensive effects was observed only during A+M therapy (target BP in SH and MH was achieved in 82.8 and 82.4%, respectively). In the control group A+L and A+M combinations increased a number of patients with normal LV geometry (85.7 and 86.7, respectively) and diastolic function (78.6 and 80%, respectively). In hypothyroidism A+M therapy resulted in more prominent increase in a number of patients with normal LV geometry (75% in both SH and MH) and diastolic function (in SH and MH 83.3 и 85.7%, respectively) than these in A+L therapy (р&lt;0.05). Conclusion. The combination of A+M has advantages over A+L combination in antihypertensive efficacy as well as in the effect on the structural and functional state of the LV myocardium in women with HT and MS associated with hypothyroidism.</p

THE IMPACT OF COMBINATION ANTIHYPERTENSION THERAPY ON THE MAIN PARAMETERS OF STRUCTURAL AND FUNCTIONAL CONDITION OF MYOCARDIUM OF THE LEFT VENTRICLE AND THICKNESS OF “INTIMA-MEDIA” COMPLEX RELATED TO THE PHENOMENON OF SALT-SENSITIVITY IN PATIENTS WITH REFRACTORY ARTERIAL HYPERTENSION

Aim. To assess the influence of combination of antihypertension therapy on the main structure-function myocardium condition of the left ventricle (LV), thickness of intima-media (IMT) in patients with refractory arterial hypertension depending on the phenomenon of salt-sensitivity.Material and methods. Totally, 192 patients included with RAH, that after assessment for salt-sensitivity were randomized to groups: 1st group — salt-sensitive patients, receiving inhibitor of angiotensinconverting enzyme (ACEi), dihydropiridine calcium antagonist (DCA), thiazide diuretic (TD) and direct renin inhibitor (DRI) aliskiren (subgroup 1A) or β-adrenoblocker (β-AB) (subgroup 1B); 2 group — salt-resistant patients, receiving ACEi, DCA, TD and aliskiren (subgroup 2A) or β-AB (subgroup 2B). At the baseline and in 48 weeks of treatment the echocardiographic study was performed.Results. Addition of DRI in 1A subgroup helped to reach target values of blood pressure (BP) in 43,3%, and in subgroup 2A — in 70,4% of patients. Usage of β-AB in subgroup 1B led to decrease of BP to target values in 54,3%, and in 2B subgroup — in 50% patients. Usage of DRI in salt-resistant patients helped significantly to regress the LV hypertrophy than in salt-sensitive. Increase of the number of persons with normalized geometry and diastolic function of the LV was comparable in both groups. Usage of β-AB in salt-sensitive and -resistant patients was followed by statistically more significant improvement of structural and functional condition of myocardium of the LV. Normalized geometry of the LV was registered significantly more commonly in slat-sensitive patients. The decrease of IMT was comparable at the background of the usage of both variants of therapy not depending from salt-sensitivity.Conclusion. Usage of DRI as combination therapy led to more significant in salt-resistant than in salt-sensitive patients, antihypertensive effect and LV hypertrophy regress. Prescription of β-AB was followed by BP decrease to target values in comparable number of patients in 1B and 2B subgroups, but had some advantages in hypertrophy regression and normalization of LV myocardium geometry in salt-sensitive patients comparing to salt-resistant