THE IMPACT OF LONG-TERM TREATMENT WITH SYMPATHETIC NERVOUS SYSTEM BLOCKERS ON BLOOD PRESSURE VALUES IN PATIENTS WITH RESISTANT HYPERTENSION

Abstract

Objective: Comparative evaluation of influence of sympathetic nervous system blockers on blood pressure values for the long-term treatment in patients with resistant hypertension. Design and method: 100 patients with essential HTN gr.3 without comorbidities after a 3-week treatment with standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized in two groups, depending on the medication supplemented to the previously administered: group I – selective I1-imidazoline agonist Moxonidine and group II – cardioselective beta-blocker Bisoprolol. All patients were evaluated by ambulatory blood pressure monitoring (ABPM) and office measurement of blood pressure at baseline, three, six and twelve months follow up. Results: At baseline office SBP and DBP values constituted 188,0 ± 3,1 mmHg and 111,2 ± 2,4 mmHg in group I versus 193,3 ± 3,2 mmHg and 114,6 ± 1,7 mmHg in group II, without differences between groups (p > 0,005). Both treatment regimens demonstrated a statistically significant comparable antihypertensive effect already after the third month of continuous medication, the benefit being maintained until the end of the study (Tab. 1). Similar dynamics were noted in the analyses of the mean SBP and DBP on ABPM measurement: statistical authenticity occurs in both groups at 3 months of medication without differences in the comparative analysis between batches. At 12 months of follow-up, Moxonidine exhibits superior antihypertensive effect over Bisoprolol, resulting in statistically significant differences in mean SBP / 24-hour reductions between groups (Tab.2).Conclusions: Medication with SNS blockers Moxonidine and Bisoprolol resulted in a statistically significant reduction in SBP and DBP values assessed in office and by ABPM starting with the 3rd month of medication, the beneficial effect being maintained until the end of the monitoring period, but without achievement of BP goal values. The Moxonidine treatment group demonstrates a superior net potency in ameliorating these parameters. Thus, Moxonidine can be recommended as an effective remedy in the treatment of resistant HTN.