Динаміка рівнів біомаркерів ендотеліальної функції у хворих на резистентну артеріальну гіпертензію під впливом лікування

Abstract

The purpose of the study was to determine the biomarker levels dynamics of endothelial function in patients with treatment resistant hypertension under the influence of treatment. Materials and methods. A comprehensive outpatient examination was conducted in 117 patients with a preliminary diagnosis of treatment resistant hypertension. 71 patients with hypertension of the stage II and 35 practically healthy individuals were examined. The quantitative content of endothelin-1 was determined by enzyme immunoassay using a set of reagents Endothelin-1 ELISA kit (Biomedica, Austria). The method for determining stable final metabolites of nitric oxide in the blood is based on the reduction of nitrates to nitrites with the determination of the latter by reaction with the Gris reagent. Results and discussion. The level of endothelin-1 between the groups of patients was significantly higher among patients with treatment resistant hypertension than among patients with hypertension of the stage II – 1.64 [1.16; 2.18] fmol/l versus 0.98 [0.73; 1.02] fmol/l, respectively, (p<0.05). The NO2 index had the lowest value in the group of patients with treatment resistant hypertension 6.00 [5.10; 7.30] mmol/l and was significantly lower by 20.0% compared to the group of patients with hypertension of the stage II – 7.50 [6.80; 9.40] mmol/L. The NO3 level among patients with treatment resistant hypertension was 13.50 [11.20; 14.80] mmol/l, which was significantly lower by 11.8% and 18.2% compared to the group of patients with hypertension of the stage II and the group of practically healthy individuals, respectively (p<0.05). In the first group, blood pressure levels <140/90 mmHg were reached by 29 (56.9%) people, which significantly exceeded the percentage in the second group – 15 (30.6%) patients (p<0.05). Treatment of patients with treatment resistant hypertension should include optimizing dosages and prescribing rational combinations of antihypertensive drugs in order to enhance synergistic effects. Among the measures to overcome low adherence to treatment of hypertension, the following should be recommended: assessment and selection of patients with low compliance (according to the Morisky-Green scale); optimization of pharmacotherapy by prescribing drugs with fixed combinations; control of drug intake. The Morisky-Green scale test should be applied at the beginning of treatment of patients with hypertension, since it allows the doctor to understand how supportive the patient is to treatment and will correctly perform the appointment. After all, only accurate and correct execution of prescriptions can bring the maximum positive effect of therapy and prevent the development of complications. The fixed combination of amlodipine-indapamide-perindopril has one important advantage, which is to increase adherence to treatment due to the principle of "one day – one pill". Conclusion. Among patients with hypertension, the development of endothelial dysfunction is noted, which increases with treatment resistant hypertension. The combination of amlodipine-indapamide-perindopril is effective in reducing blood pressure and correcting endothelial dysfunction. The use of a fixed combination of amlodipine-indapamide-perindopril in the form of a single pill by patients is accompanied by a large percentage of those who have reached blood pressure levels <140/90 mmHg