Abstract
The aim: to evaluate the effectiveness of different fixed double antihypertensive combinations based on the results of outpatient monitoring of arterial pressure and to analyze their effect on central arterial pressure and cardiac remodeling in patients with arterial hypertension and thyrotoxicosis. Materials and methods: patients with hypertension and TT who were included in the study were divided into groups using the blind envelope method with compensated TT: patients of group 1 were prescribed a fixed combination of perindopril with indapamide, group 2 - a combination of perindopril with amlodipine. Patients with uncompensated TT were prescribed a combination of bisoprolol with perindopril. The groups were statistically comparable in terms of age, duration of AH and TT, SBP and DBP levels. The observation of the patients lasted 12 months. After a year of follow-up, AMAD and EchoCG were performed in order to study AHT in patients with hypertension and TT. The patients were consulted by a cardiologist and endocrinologist. Results: After 6 months of treatment, 8 (16 %) patients were excluded from the study, of which 6 (75 %) due to the need for surgical treatment and did not achieve euthyroidism, 2 (25 %) due to the need for antiarrhythmic therapy. Studied double fixed combinations effectively reduce blood pressure (BP) according to the results of ambulatory blood pressure monitoring (ABPM). Conclusions: The fixed combination of perindopril with indapamide, perindopril with amlodipine, bisoprolol with perindopril provided a decrease in both blood pressure according to ABPM results and central pressure, however, this was not accompanied by a significant improvement in the structural and functional state of the heart
Highlights
Study of the features of arterial hypertension (AH) on the background of thyroid dysfunction (TD) showed that AH is more closely associated with hyperthyroidism than with hypothyroidism [1]
Indicators that characterize the daily systolic blood pressure (SBP) profile (24 SBP, aSBPday, aSBPnight) after 12 months of treatment in both groups AHT were significantly lower than when included in the study (p
After one year of treatment, all studied double fixed combinations of AHD showed a statistically significant decrease in ABPM, but in the group of patients receiving a fixed combination of bisoprolol with perindopril showed a significant decrease in the indicators that characterize the daily profile of SBP (24 SBP, aSBPday, aSBPnight), as well as heart rate (HR), i. e. the achievement of euthyroidism further contributed to the reduction of blood pressure (BP)
Summary
Study of the features of arterial hypertension (AH) on the background of thyroid dysfunction (TD) showed that AH is more closely associated with hyperthyroidism than with hypothyroidism [1]. Yildiz C. and et al (2019) found in patients with thyrotoxicosis (TT) a significant increase in systolic blood pressure (SBP), heart rate (HR) and central SBP, which is an independent risk factor for cardiovascular complications, which is more accurate than the level of peripheral blood pressure (BP) displays after loading of the left ventricle (LV) and closely correlates with the left ventricular myocardial mass index (LVMMI) n patients with AH [2, 3]. According to the results of a professional study of the restoration of clinical, instrumental indicators of the cardiovascular system in patients with diffuse toxic goiter after elimination of thyrotoxicosis, neither in conservative therapy nor in the use of surgical treatment of reversibility of symptoms in most patients was not observed [5]
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