Опыт комбинированной антигипертензивной терапии у больных с метаболическим синдромом

Abstract

The aim of the study was to achieve target blood pressure (BP) level in metabolic syndrome (MS) patients receiving two antihypertensive medications, in order to compare systemic metabolic effects of the latter. This open study included 20 patients (12 females, 8 males), mean age 54 ± 3 years, diagnosed with MS by NCEP ATP III (2001) criteria. After a wash-out period, all participants were administered spirapril (6 mg/d). Four weeks later, if target BP was not achieved, nifedipine retard was added (40 mg/d). After 3 months of the therapy, in 18 patients (90 %) target BP level was achieved: in 11, with spirapril monotherapy (6 mg/d); in other 9 patients, with spirapril and nifedipine retard (40 mg/d). In total, systolic BP decreased by 11 %, diastolic BP - by 14 % from the baseline levels. Combined antihypertensive therapy was associated with decrease in triglycerides level by 28 %, increase in high-density lipoprotein cholesterol (CH) level by 6 %. Total CH, low-density lipoprotein CH levels and atherogenicity index remained the same. Fasting and two-hour post-load glucose levels (oral glucose tolerance test) did not change, and fasting immuno-reactive insulin concentration significantly decreased by 34 %. As a result, insulin resistance marker level decreased by 35 %. The treatment was well-tolerated, transitory adverse effects did not result in therapy withdrawal. Therefore, combination of ACE inhibitor, spirapril, and dihydropyridine calcium antagonist, nifedipine retard, can be regarded as one of effective and safe antihypertensive combinations in MS patients.