Pathogenetic treatment of patients with hypertension depending on the level of sympathоadrenal system activity

Abstract

Purpose of the study. Recently, new opportunities to optimize clinical efficacy and tolerability of treatment of patients with essential hypertension appeared. Determination of the indicators of increased activity of the sympathetic nervous system (SNS) in practice could contribute to differentiated treatment of patients with hypertension. Comparative estimation of influence of complex treatment with bisoprolol or amlodipine on the SNS activity parameters in patients with arterial hypertension (AH) of II stage.
 Materials and methods. 121 patients (men and women) with documented II stage AH were examined clinically. Concentrations of adrenaline, noradrenaline, dopamine and DOPA in urine were evaluated by spectrochromatography, endotheliumdependent vasodilation was studied using complex rheographic ReoCom Professional (HAI-Medicom, Ukraine). Patients were divided into 2 groups: if concentration of noradrenalin in urine exceeds healthy subjects levels more than on 20% – patients were added to basic treatment (enalapril, atorvastatin, aspirin) bisoprolol, if concentration of noradrenalin in urine exceeds healthy subjects levels less than on 20% – we added amlodipine. Statistic analysis was done on Apache OpenOffice (version 4.1) and PSPP (version 0.7.9).
 Results. The study showed that after treatment there was significant decrease of adrenalin, noradrenalin in 1st group . Increase of DOPA levels was higher in 1st group (Δ% = +46,5 [30,0; 55,4]% vs Δ% = +8,8 [–2,1 ; 16,0]%, (p < 0,05).). Trends in daily urinary excretion of adrenaline (–44,8%) and norepinephrine (–33,7%) showed the impact of effective Δ-blocker on the activity of pressor systems. DOPA excretion was increased significantly in both groups which can indirectly indicate hemodynamic load reduction in hypertensive patients. When choosing the individual antihypertensive treatment in patients with arterial hypertension, if excretion of noradrenalin is increased it is rationally to add adjuvant therapy with β-blockers.
 Conclusion. The results of our research can be applied into the practice of general practitioner as recommendations for individual selection of antihypertensive treatment depending on the activity of sympathetic nervous system.