Abstract
Actuality. The effect of drugs on adaptation to abnormal temperatures is one of the most important questions put to practical medicine by the heat waves of recent years. One of the controversial issues - safety of use during the heat wave of calcium channel blockers (ACC) and blockers of receptors for angiotensin II (ARBS). The goal is to evaluate the efficacy and security of treatment of patients with arterial hypertension (AH) during the heat wave of a fixed combination of ARBS+ACC (Lortenza, KRKA). Materials and methods. Included 26 patients with hypertension 1 and 2 degrees from 42 to 81 years. All patients underwent measurement of office blood pressure, electrocardiography, body sphygmography with the determination of the pulse wave velocity and selectively CAVI, biochemical analysis of blood, estimation of osmolarity of blood, questionnaire: visual analogue scale, a questionnaire for patients exposed to heat, the test of adherence to treatment Moriscos-Green. Estimated diaries of self-control of blood pressure. The inclusion visit took place in spring 2016, 1st visit was in May - June 2016, 2nd - during heat waves, 3rd - September - October 2016. Results. The observed decrease in systolic blood pressure and diastolic blood pressure (p=0.000) to the target values, preserved for the whole period of observation. According to the diaries of self-control of blood pressure controlled blood pressure 81% of patients. During a heat wave, this value decreased to 58%, in autumn - to 63%. The 3rd visit achieved a reduction in heart rate at -6.0 (-11.1; and 2.8) beats/min; p=0.007. A noticeable decrease of the pulse wave velocity from 15.2±3.4 to 14.4 V±3.0 m/s; p=0.01 and CAVI in of-2.1 (to -2.9; -0.65); p=0.01; the decline in uric acid level c of 415.3 to 346.2 mmol/l (p=0.04) and creatinine on the 2nd visit compared to baseline (p=0.02). Electrolyte shifts and increasing the osmolarity of the blood during heat waves have not been identified. There is a growing commitment therapy (p=0.04) and quality of life to 20.0 (7.4; 23.3); p=0.000 by visual analogue scale. Conclusion. Fixed combination of losartan and amlodipine (Lorenza) is an effective, safe and may be recommended for patients receiving AG in the hottest period.
Highlights
The effect of drugs on adaptation to abnormal temperatures is one of the most important questions put to practical medicine by the heat waves of recent years
All patients underwent measurement of office blood pressure, electrocardiography, body sphygmography with the determination of the pulse wave velocity and selectively CAVI, biochemical analysis of blood, estimation of osmolarity of blood, questionnaire: visual analogue scale, a questionnaire for patients exposed to heat, the test of adherence to treatment Moriscos–Green
The inclusion visit took place in spring 2016, 1st visit was in May – June 2016, 2nd – during heat waves, 3rd – September – October 2016
Summary
Дизайн исследования Дизайн исследования представлен на рис. 1. 0-й визит (март – май 2016 г.). При необходимости – титрация дозы препаратов на дополнительных визитах между 0 и 1-м или 1–3-м. Через 3 дня от начала тепловой волны и до 3-го дня после ее окончания, происходил активный вызов пациентов для их повторного обследования и при необходимости коррекция терапии. Сравнение значений с распределением признаков, отличным от нормального, проводилось с помощью критерия Манна– Уитни. Непрерывные переменные, имеющие нормальное распределение или умеренно отклоняющиеся от нормального, представлялись как М±σ, где М – среднее и σ – стандартное отклонение. АД (САД) и диастолического АД (ДАД) до целевых значений, сохранившееся на весь период наблюдения По данным дневников самоконтроля АД (СКАД), контроль АД На 3-м визите целевой уровень АД по данным СКАД поддерживали 63% участника исследования На 3-м визите целевой уровень АД по данным СКАД поддерживали 63% участника исследования (рис. 2)
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