ANTIHYPERTENSIVE EFFICACY OF A STRATEGY FOR SWITCHING FROM FREE COMBINATIONS TO A FIXED TRIPLE COMBINATION AS ASSESSED BY VASCULAR STIFFNESS PARAMETERS

Abstract

Objective: To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine/indapamide/perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN). Design and method: The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine/indapamide/perindopril. The patients were divided into three amlodipine/indapamide/perindopril therapy groups: 1-5/1.25/5mg, 2-5/2.5/10mg, 3-10/2.5/10mg. Control visits were after 4 weeks, 12 weeks, 24 weeks of therapy. At each visit, the achievement of the target BP level <130/80mmHg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPM. Results: When screening, AHT included 2 drugs - 12 (15.3%) patients, 3 or more - 66 (84.6%), free combinations of drugs 56 (71.8%), FC - 32.1%, respectively. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p < 0,05) as well as ASI (174 (138,253) vs 139 (107,196) mmHg; p <0.001) and Aix -29,9(-41,12) vs - 33,7(-53, 9) p<0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta. In the analyzed group of patients, the initial blood pressure was 160.8 ± 10.3/91.5 ± 8.1 mm Hg, after 24 weeks the blood pressure decreased to 121.3 ± 3.5/73.6 ± 4.2mm Hg.st. (p <0.001). According to ABPM data, daily BP significantly (p <0.001) decreased from 153.9 ± 9.04/8.38 ± 9.18 to 120.3 ± 4.7/73.4 ± 4.7 mm Hg after 24 weeks of TFC therapy. Similar patterns were received for the night BP. Conclusions: Indicators of vascular stiffness, together with target BP figures, can serve as criteria for monitoring the quality of blood pressure and have been used to assess the effectiveness of antihypertensive therapy when switching patients to TFC amlodipine/indapamide/perindopril.