Possibilities of achieving target levels of arterial pressure and atherogenic lipids in patients with arterial hypertension with obesity at the outpatient stage (results of a 12-week follow-up)

Abstract

The aim: To study the possibility of achieving target levels of blood pressure (BP) and atherogenic lipids’ levels in patients with arterial hypertension with abdominal obesity (AO) using combined antihypertensive and lipid‑lowering therapy against the background of recommendations for lifestyle correction at the outpatient stage.
 Materials and methods. The study involved 54 patients with AH of 2 and 3 degrees with AO of I — II degrees, who were examined in the polyclinic of the GI «L. T. Malaya Therapy National Institute of the NAMS of Ukraine». The investigated group included 30 (56 %) men and 24 (44 %) women, aged 47 to 59 years (the mean age — (50.6 ± 5.2) years). All patients underwent general clinical laboratory and instrumental examinations. After the initial examination, all patients were prescribed a three‑component fixed combination (FC) of antihypertensive drugs: an angiotensin‑converting enzyme inhibitor (ACE inhibitor) perindopril, a thiazide‑like diuretic (TPD) indapamide and a long‑acting dihydropyridine calcium channel blocker (CCB) amlodipine in optimal daily doses, considering blood pressure levels. Atorvastatin was administered as a lipid‑lowering drug in a daily dose, defined depending on the initial blood levels of low‑density lipoprotein cholesterol (LDL cholesterol). Achievement of the target levels of blood pressure and LDL‑cholesterol was assessed after 6 and 12 weeks of the study. Doses of antihypertensive drugs and atorvastatin were adjusted during the study.
 Results. It has been established that 6 weeks of treatment of AH patients with AO in outpatient settings with the use of three‑component fixed combination of antihypertensive drugs (ACE inhibitors, TPD and CCBs of the dihydropyridine series) and statins’ lipid‑lowering therapy against the background of recommendations for lifestyle correction, resulted in the achievement of the target “office” BP levels of in only 57 % of patients and target levels of LDL‑cholesterol in only 32 %. Insufficient efficacy of antihypertensive therapy in the examined patients was associated with a greater severity of obesity, increased heart rate (HR) and a higher incidence of left ventricular hypertrophy (LVH), while the low efficacy of statin therapy was primarily associated with the low therapy compliance. The addition of nebivolol, cardioselective beta‑adrenoblocker (BAB) with a vasodilatory effect, to the fixed combination of ACE inhibitors, TPD and BCC significantly increased the effectiveness of antihypertensive therapy. At the same time, intensification of statin therapy did not result in the significant increase of the frequency of achieving target levels of LDL cholesterol in the blood.
 Conclusions. The standard three‑component fixed combination of antihypertensive drugs in combination with medium‑dose statin therapy and recommendations for the normalization of lifestyle was not enough effective in a significant part of AH patients with AO at the outpatient stage, which indicates the need for timely correction of drug therapy and implementation of healthy lifestyle.