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

Abstract

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