Features of antihypertensive pharmacotherapy in patients with metabolic syndrome and diabetes mellitus

Abstract

The article describes the results of analyzing the available literature concerning specifics of pharmacotherapy for hypertension in elderly patients and patients with metabolic syndrome and diabetes mellitus. Authors present statistical data on the prevalence of hypertension among elderly patients and the incidence of obesity and diabetes in the Russian Federation. The paper highlights the characteristics of clinical course of hypertension in the older age group including the predominance of isolated systolic hypertension, vascular stiffness, and increased endothelial dysfunction. The need for administration of antihypertensive drugs to reduce the risk of complications and improve the quality of life even in older patients is confirmed. The analysis of data from numerous large studies allowed the authors to identify the main principles for selecting antihypertensive drugs in elderly patients. Slow calcium channel blockers, angiotensin converting enzyme inhibitors, and low-dose diuretics should be prescribed as first-line drugs. At the next stage of treatment, in case of unsatisfactory results of initial therapy, the addition of mineralocorticoid receptor antagonists, alpha-blockers, and selective imidazoline receptor agonists should be considered. The main approaches to antihypertensive therapy in patients with metabolic syndrome and diabetes mellitus are described. The authors note the fact of unfavorable impact of metabolic syndrome on cardiovascular system, which provides rationale for aggressive treatment of hypertension in such clinical cases where several drugs may be used to achieve a stable antihypertensive effect. Diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers are recommended as first-line antihypertensive pharmacotherapy in these patients. The authors argue in favour of the use of antihypertensive drug combinations in one dosage form as one of the effective ways to solve the problem of adherence to treatment in elderly patients and patients with concomitant metabolic disorders.