IMPROVING AN EFFICIENCY OF RESISTANT HYPERTENSION TREATMENT WITH FIXED DOSE COMBINATION OF 3-COMPONENTS ANTIHYPERTENSIVE MEDICATION

Abstract

Objective: Improving an efficiency of resistant hypertension treatment with fixed dose combination of 3-components antihypertensive medicationDesign and method: 180pts with the preliminary diagnosis of RAH,which was confirmed by24-h ambulatory blood pressure monitoring(ABPM),were included in the study. All pts received an average of4.1 ± 0.3 antihypertensive drugs, mainly in free combinations. After ABPM pts were started treatment with 3-component fixed dose combination (FDC) of antihypertensive drugs:the FDC of perindopril10 mg/indapamide2.5 mg/amlodipine10mg(108pts)or the FDC of valsartan320 mg/hydrochlorothiazide25 mg/amlodipine10mg(72pts). The adherence to the treatment was evaluated by the Morisky-Green test (MGT) at the initial examination and after 3 months of treatment with the FDC of antihypertensive drugs. Results: The average level of office systolic BP (SBP) and diastolic BP (DBP)was158.1 ± 1.2 and 91.03 ± 0.9mmHg respectively. After 3 months of treatment with 3-components FDC, according the results of office and ambulatory BP measurements,RAH was confirmed at 78pts and 102pts achieved the target blood pressure level (these pts were classified as pts with controlled arterial hypertension (CAH)). RAH pts were older than CAHpts:52.4 ± 1.2vs49.8 ± 1.6years (p = 0.02). Both groups were dominate by men-60.5%among RAH pts and62.6% among CAH pts. But initial BP levels (office and ambulatory)were higher in RAH group (tab.1). In the CAH group the office SBP decreased by 21%,DBP-by19.5%,the average daytimeSBP and DBP by15.2 and14% respectively,the average nighttime SBP and DBP by16.7 and16.4% respectively. In the RAH group BP lowering was smaller:the office SBP decreased by13.2%,DBP - by9%,the average daytime SBP and DBP by10.3and8.7% respectively,the average nighttime SBP and DBP by11.1and10.2% respectively. All pointed changes of BP were significant (p < 0.001)(tab.1). The results of the Morisky-Green tests show that treatment with FDC of antihypertensive drug leaded to improvement of the adherence to therapy. The initial Morisky-Green rate,which was assessed retrospectively,at RAH pts was1.3 ± 0.1points and at CAH pts1.4 ± 0.1 (p > 0.05),after 3-months of treatment with 3-components FDC it elevated to 2.5 ± 0.2 and 2.6 ± 0.2 points, respectively, in both groups (p < 0.005). Conclusions: Thereby, administration of 3-components FDC (RAAS blocker/diuretic/calcium channel blocker)improves the adherence to treatment, which can probably ameliorate the efficacy of antihypertensive treatment. Perhaps,the use of 3-component FDC in patients with a diagnosis of RAH could help to achieve the effective BP control and reduce the necessity of adding the 4-th antihypertensive drug for achieving of goal BP.