Оценка параметров суточного мониторирования артериального давления у больных с бессимптомной гиперурикемией на фоне лечения лозартаном, эналаприлом и лизиноприлом

Abstract

The purpose of the study was to identify features of the circadian rhythm of blood pressure in patients with arterial hypertension in the presence of hyperuricemia and to assess the impact of monotherapy with losartan, enalapril, and lisinopril on circadian blood pressure profile, the level of uric acid and lipid profile. The study included 76 patients attending the clinic, in the presence of arterial hypertension degree I and II in conjunction with hyperuricemia. We conducted clinical examination, echocardiography, 24-hour monitoring of arterial blood pressure, kidney ultrasound, lipid profile, and determined the levels of uric acid in the blood and in the daily urine. Patients were divided into three groups: I (n=30), II (n=22), and III (n=24) who received monotherapy with losartan, enalapril, and lisinopril, respectively. The duration of drug intake by patients of all groups was 12 weeks. In patients with a combination of arterial hypertension and hyperuricemia, we identified dysregulation of blood pressure, evidenced by the increases in the time indexes for systolic and diastolic blood pressure, variability and increase in the morning systolic blood pressure rise, contributing to the development of the load on the target organs, in particular, leading to the left ventricle hypertrophy. The 24-hour arterial blood pressure monitoring showed that predominant types of inversion of the systolic and diastolic blood pressure circadian rhythms were insufficient reduction (non-dipper) in 58-67% and nocturnal hypertension (knight-picker) in 18-33% of cases, with the worst parameters of systolic and diastolic blood pressure registered at nighttime. The study revealed that impact of therapies on the level of blood pressure was comparable. The normalization of the circadian dipper blood pressure profile was observed almost in half of patients. However, moderate decrease in the level of uric acid in the blood and increase in the uric acid excretion occurred only in case of monotherapy with losartan.