The efficacy of the combined antihypertensive and statin therapy in patients with hypertension and excessive body mass

Abstract

Objective — to assess the effects of the of the combined therapy with fixed combinations of antihypertensive medications in combination with statin on the indices of systemic hemodynamics, lipid profile, carbohydrate metabolism and adipocytokines production in overweight patients with essential hypertension of II stage.Materials and methods. The investigation involved in-hospital 64 hypertensive (stage II) patients, the mean age 59.0 (48.0 — 63.0) years with excessive body mass (body mass index > 25 kg/m2), who were treated in the therapeutic department No. 1 of the medical and sanitary unit of JSC “Motor Sich” in the years 2016 — 2018. and met the study inclusion criteria. All patients underwent general clinical, laboratory and instrumental examination to verify the diagnosis, determine complications and comorbidities. The patients were randomized into two subgroups who were administered fixed combinations of antihypertensive drugs for 120 days. Patients of the first subgroup (n = 32) received a combined drug «Equator» («Gedeon Richter», Hungary) in an initial dose of 1 tablet (amlodipine — 5 mg and lisinopril — 10 mg) per day, patients of the second subgroup (n = 32) received Valodip (KRKA, Slovenia) in an initial dose of 1 tablet (amlodipine — 5 mg and valsartan — 80 mg) per day. Within 2 weeks, the dose of drugs was adjusted if necessary. All patients were administered Rosuvastatin (Roxera, KRKA) in a dose of 10 mg/day.Results. The change in the doses wasn’t required for 10 (31.3 %) patients from the first subgroup and 13 (40.6 %) from the second subgroup; for the rest of patients, the doses of drugs were increased as follows: Equator (amlodipine — 5 mg and lisinopril — 20 mg) 1 tablet per day and «Valodip» (amlodipine — 5 mg and valsartan — 160 mg) 1 tablet per day. The target blood pressure level (130/85 mm Hg) was achieved in 24 (75.0 %) patients in the first group and in 26 (81.3 %) in the second. During treatment in both subgroups, the following positive changes were observed: in systemic hemodynamic parameters there were normalization of systolic and diastolic blood pressure and improved cardiac pumping function; in lipid spectrum — the decreased levels of total cholesterol, low-density lipoprotein cholesterol against the background of an increase in high-density lipoprotein cholesterol. Moreover the carbohydrate metabolism improved (fasting blood glucose decreased) and adipocytes production normalized — the levels of proinflammatory cytokines (interleukin-1β (IL-1β) and tumor necrosis factor-α) decreased and anti-inflammatory IL-10, adiponectin increased.Conclusions. The reduced production of pro-inflammatory and increased production of anti-inflammatory cytokines and adiponectin against the background of normalization of the indices of systemic hemodynamics, the decrease of pro-atherogenic and raise in the antiatherogenic fraction of blood lipids, reduction of the glycemia level in the patients with hypertension and excessive body mass under the influence of the therapy with fixed combinations of antihypertensive drugs with the use of both angiotensin-converting inhibitors and sartans, with the addition of statins, showed the efficacy of such therapy and its capability to considerably reduce the cardiovascular risk in this category of patients.