The effectiveness of treatment of patients with stable coronary heart disease and concomitant arterial hypertension: the results of a multicenter study PRESTOL

Abstract

The aim – to evaluate the profile of patients with coronary heart disease (CHD) and concomitant arterial hypertension (AH) who were administered bisoprolol as part of previous therapy, but did not reach normal levels of heart rate and blood pressure; to estimate the percentage of getting to recommended levels of heart rate, blood pressure and treatment adherence in patients after 4 weeks of using the fixed-dose combination of bisoprolol/perindopril with a correction of doses.Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure above 140/90 mm Hg, heart rate above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CHD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered.Results and discussion. 2785 patient questionnaires were provided by doctors, 2394 (86 %) of them met the inclusion criteria. The mean age of the patients was 61.4 years, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 751 (31.7 %), a history of documented myocardial infarction – 1281 (53.5 %), coronary ventriculography (VHR) – 735 (30.7 %), revascularization (CABG/stenting) – 474 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (heart rate ≤ 70 bpm reached 84.9 % of patients, blood pressure ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks from 4.4 to 2.6 per week and the need for nitroglycerin from 4.8 to 2.7 tablets per week, to improve therapy adherence in 66.5 % of patients.Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension, including those who had myocardial revascularization and myocardial infarction in anamnesis, helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, to increase adherence to therapy.