Эффективность фиксированной комбинации амлодипин/лизиноприл у курящих пациентов с артериальной гипертонией

Abstract

Objective. To conduct a comparative analysis of blood pressure (BP) profile characteristics in middle-aged (45-65 years) patients with stage 1-2 hypertension not associated with comorbid cardiovascular disease depending on smoking status; to estimate the influence of fixed combination of amlodipine and lisinopril (FC A/L) use on these characteristics. Materials and methods. At the first stage of the study 60 untreated patients (31 men, 29 women, mean age 53.6±0.8 years) with stage 1-2 hypertension were divided in two groups according to smoking status. The smoking group included 11 men and 11 women with mean age 53.4±1.2 years, non-smoking group - 20 men and 18 women with mean age 53.7±1.0 years. Ambulatory blood pressure monitoring (ABPM) (monitor MDP-НС-02с, DMS) and BP measurement based on Korotkov sound technique as well as transthoracic echocardiography were performed in all patients. At the second stage a subgroup of 30 untreated patients (16 men, mean age 52.7±1.11 years, 40% smokers [12 patients]) was formed. Patients received FC A/L (Ekvator®) with starting dose 5 mg/10 mg titrated every 14 days until target BP lower than 140/90 mm Hg was reached. The therapy was continued for 12 weeks, after that ABPM was performed again. Results. In smokers and non-smokers with hypertension no significant differences in BP levels in office BP measurement and ABPM were observed. At the second stage all 30 patients receiving FC A/L reached target office BP levels. In subgroups of smokers and non-smokers with hypertension significant office systolic BP (p<0.001 in both groups), diastolic BP (p<0.001 in both groups), and pulse BP (p<0.05 and р<0.001, respectively) reduction was observed on FC A/L treatment. There were no significant differences in office BP dynamics between subgroups. At the end of follow-up a significant decrease of systolic BP within 24 hours (p<0.001 in both groups), diastolic BP within 24 hours (p<0.001 in both groups), and pulse BP within 24 hours (р<0.01 and p<0.001, respectively) was observed. A significant decrease of day systolic and diastolic BP (p<0.001 for both parameters in both groups) and also pulse BP (p<0.01 and p<0.001, respectively) was observed in both groups of patients. A significant decrease of night systolic BP (p<0.001 in both groups), diastolic BP (p<0.01 and p<0.001, respectively), and pulse BP (p<0.01 in both groups) was observed in smokers and non-smokers. There were no significant differences between the groups in systolic, diastolic, and pulse BP dynamics according to ABPM. There was a significant reduction in systolic day BP variability (p<0.01 and p<0.05, respectively) and diastolic night BP variability (p<0.001 и p<0.05, respectively) in smokers and non-smokers on FC A/L therapy. In hypertensive smokers a significant reduction of diastolic day BP variability was also observed (p<0.05). Conclusions. Smoking does not influence a 24 hours BP profile in patients aged 45-65 years with stage 1-2 hypertension. The FC A/L use in these patients has antihypertensive effect regardless of smoking status.