Abstract
Objective. To determine the comparative effectiveness of atorvastatin and rosuvastatin in relation to individual biochemical and functional markers of vascular wall remodeling in patients with arterial hypertension of high cardiovascular risk. Materials and methods. The study included 140 patients with stage II of arterial hypertension (AH), II-III degree of severity with the duration of the disease from 5 to 12 years, who, against the background of antihypertensive therapy (enalapril 20-40 mg/day, indapamide retard 1.5 mg, metoprolol 100-150 mg/days) received atorvastatin 20 mg/day for 1 year, subsequently it was replaced by rosuvastatin 10, 20, 40 mg / day. The dose regimen was determined by achieving the target level of cholesterol (CS) and low density lipoprotein cholesterol (LDL-C). Results. Taking atorvastatin for 1 year was accompanied by a decrease in the value of the cardio-ankle vascular index (CAVI) by 14.4%, the augmentation index (AI) - by 10.3%. The replacement of atorvastatin with rosuvastatin was accompanied by a further decrease in the R-CAVI value: by 10.8% (20 mg/day) and 14.4% (40 mg/day). The use of atorvastatin for 1 year was accompanied by a decrease in both C-reactive protein (CRP) (by 26.0%) and osteopontin (OP) (by 22.8%). A further decrease in the concentration of CRP by 18 months of rosuvastatin therapy is recorded when using mean and high doses (20-40 mg/day). Differences in the severity of changes in CRP level between the groups were significant (p<0.05). The level of OP in comparison with the beginning of rosuvastatin decreased by 32.9%. Differences in the degree of reduction of OP when taking rosuvastatin between the groups were significant (P<0.05). Conclusion. Rosuvastatin in various dosage regimens with long-term use in patients with arterial hypertension with a high vascular risk reduces the content of CRP and OP in blood, reduces the CAVI and the AI, and is more effective than 20 mg atorvastatin a day.
Highlights
Цель работы – определить сравнительную эффективность аторвастатина и розувастатина в отношении отдельных биохимических и функциональных маркеров ремоделирования сосудистой стенки у больных артериальной гипертонией высокого сердечно-сосудистого риска
Taking atorvastatin for 1 year was accompanied by a decrease in the value of the cardio-ankle vascular index (CAVI) by 14.4%, the augmentation index (AI) – by 10.3%
The use of atorvastatin for 1 year was accompanied by a decrease in both C-reactive protein (CRP) and osteopontin (OP)
Summary
В исследование включено 140 больных АГ II стадии, II-III степени тяжести, в возрасте от 45 до 59 лет (55,4±4,3, мужчин – 118, женщин – 22), продолжительность болезни от 5 до 12 лет, риск (по SCORT) высокий или очень высокий. При включении в исследование больным в условиях амбулаторно-поликлинического наблюдения был назначен аторвастатин 20 мг/сут, который они получали в течение 1 года, но не достигли целевой уровень ХС и ХС ЛНП [3]. Продолжительность лечения розувастатином и наблюдения составляла 18 мес., при этом дозу 10 мг/сут получали 90 пациентов, 20 мг/сут – 24 человека, 40 мг/сут – 26 больных. В качестве гипотензивной терапии больные получали эналаприл 20-40 мг/сут, индапамид ретард 1,5 мг, при недостижении целевого АД лечение дополнялось метопрололом 100150 мг/сут, дозовые режимы определялись эффективностью терапии. Для повышения приверженности к лечению при включении в исследование и каждые 6 мес. Величина коэффициента дисфункции сосудистого эндотелия у больных АГ высокого и очень высокого риска на фоне терапии статинами (M±m), N=140 (N1=90; N2=24; N3=26).
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