24-hour blood pressure monitoring in hypertensive patients with abdominal obesity in the dynamics of antihypertensive treatment

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background 24-hour blood pressure monitoring (ABPM) is an additional method for examining patients with arterial hypertension (AH). The list of indications for its implementation is constantly expanding. One of the most important indications is the evaluation of the effectiveness of treatment against the background of physical and emotional stress. Aim study of the parameters of 24-hour blood pressure monitoring in patients with AH and AO in the dynamics of antihypertensive therapy. Methods 120 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: ACE inhibitors perindopril, thiazide diuretic indapamide and calcium antagonist amlodipine once in the morning at doses: 4 mg / 1.25 / 5 mg; 4 mg / 1.25 / 10 mg; 8 mg / 2.5 / 5 mg; 8 mg / 2.5 / 10 mg. ABPM was performed according to the standard method before and after 6 months of treatment. Results 24-hour systolic blood pressure (SBP) and 24-diastolic blood pressure (DBP) in patients were 148 (141-158) / 97 (81-101) mm Hg. 24-hour pulse blood pressure - 59 (51-63) mm Hg. The SBP time index was 86 (67-96)%, the DBP time index was 84%. Daytime SBP variability in patients was 17 (11-20) mm Hg, daytime DBP variability was 13 (8-14) mm Hg. SBP variability at night was 14 (9-13) mm Hg, DBP variability at night was 10 (8-12) mm Hg. As a result of treatment, the target blood pressure level was achieved in 69% of the examined according to the data of the office measurement of blood pressure and in 50% of the patients according to the results of ABPM. The number of patients with pathological variability of blood pressure decreased from 47% to 25% (p <0.05). An excessive morning rise in SBP at the beginning of the study was noted in 30% of patients, and at the end of the observation - in 15% (p <0.05). Morning BP dynamics was in 43%, and after therapy in 23% (p <0.01). The number of patients with nocturnal hypertension decreased from 75% to 35% after 6 months of treatment (p <0.0001). The distribution of patients by blood pressure profiles revealed that at the beginning of the study, the "diper" type was in 44% of the patients, the "over-diper" type in 22% of the patients, the "non-diper" type was in 28%, and the "night-picker" type was observed at 6%. After 6 months of treatment, the number of patients with the "diper" profile increased to 73%, and the number of patients with the "over-diper" profile decreased to 7%, the number of patients with unfavorable non-diper and night-picker profiles changed to 5% and 1% of patients, respectively. Conclusion The fixed combination of perindopril, indopamide and amlodipine led to the normalization of all parameters of the 24-hour BP profile in hypertensive patients with AO. Treatment was not accompanied by metabolic disturbances in these patients.