Факторы, определяющие выбор терапии у пациентов с артериальной гипертензией и нарушениями углеводного обмена на примере коренного населения Горной Шории

Abstract

Aim: to evaluate the antihypertensive efficacy of two drug combinations, RAAS inhibitor plus calcium antagonist or RAAS inhibitor plus a diuretic, in hypertension and carbohydrate metabolism disorders using a small population of the Shoria people as an example. Patients and Methods: this study included 901 indigenous inhabitants of the Mountain Shoria over 18 years. 40.7% were diagnosed with hypertension according to the Guidelines of the Russian Scientific Society of Cardiologists/Russian Medical Society on Hypertension (2010). The prospective study enrolled 320 treatment-naive patients with hypertension. Participants were randomized into two groups using envelopes. Group 1 patients (n=160) received RAAS inhibitor plus calcium antagonist. Group 2 patients (n=160) received RAAS inhibitor plus thiazide-like diuretic. Each group was divided into two subgroups, i.e., patients with isolated hypertension or patients with hypertension and carbohydrate metabolism disorders (impaired fasting glycemia, impaired glucose tolerance, diabetes). Blood pressure (BP) <140/90 mm Hg was considered the target level. Results: drug class choice and accompanying risk factors determined the efficacy of hypertension in the indigenous population of the Mountain Shoria. Both combinations (RAAS inhibitor plus calcium antagonist or RAAS inhibitor plus diuretic) were equally effective in patients with isolated hypertension or hypertension and carbohydrate metabolism disorders (56.4% and 43.9%, respectively, р=0.121). However, when prescribing RAAS inhibitor plus a diuretic, group 1 patients achieved the target BP more often than group 2 patients (59.2% vs. 38.7%, р=0.012). Moreover, in the Shoria inhabitants with hypertension, carbohydrate metabolism disorders, and obesity (particularly abdominal obesity), RAAS inhibitor plus calcium antagonist were more effective than RAAS inhibitor plus diuretic (59.3% vs. 44.0%, р=0.037). Similar findings were reported in participants with other disorders, e.g., left ventricular hypertrophy and increased intima-media thickness. Conclusions: the sensitivity of patients with hypertension to various classes of antihypertensives and its effective treatment is determined by numerous recognized factors. However, ethnicity is also to be considered. Conclusions: the sensitivity of patients with hypertension to various classes of antihypertensives and its effective treatment is determined by numerous recognized factors. However, ethnicity is also to be considered. KEYWORDS: treatment efficacy, antihypertensive combination, hypertension, carbohydrate metabolism disorders, ethnicity. FOR CITATION: Mulerova T.A., Ogarkov M.Yu. Factors determining drug choice in patients with hypertension and carbohydrate metabolism disorders considering ethnicity. Russian Medical Inquiry. 2021;5(9):568–574 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-568-574.