Antihypertensive Efficacy Research Articles

Transcatheter non-contact microwave ablation may enable circumferential renal artery denervation while sparing the vessel intima and media.

Trials of transcatheter renal artery denervation (RDN) have failed to show consistent antihypertensive efficacy. Procedural factors and limitations of radiofrequency ablation can lead to incomplete denervation. The aim of the study was to show that non-contact microwave catheter ablation could produce deep circumferential perivascular heating while avoiding injury to the renal artery intima and media. A novel microwave catheter was designed and tested in a renal artery model consisting of layers of phantom materials embedded with a thermochromic liquid crystal sheet, colour range 50-78°C. Ablations were performed at 140 W for 180 sec and 120 W for 210 sec, delivering 25,200 J with renal arterial flow at 0.5 L/min and 0.1 L/min. Transcatheter microwave ablations 100-160 W for 180 sec were then performed in the renal arteries of five sheep. In vitro, ablations at 140 W and 0.5 L/min flow produced circumferential lesions 5.9±0.2 mm deep and 19.2±1.5 mm long with subendothelial sparing depth of 1.0±0.1 mm. In vivo, transcatheter microwave ablation was feasible with no collateral visceral thermal injury. There was histological evidence of preferential outer media and adventitial ablation. Transcatheter microwave ablation for RDN appears feasible and provides a heating pattern that may enable more complete denervation while sparing the renal arterial intima and media.

Efficacy of various antihypertensive drugs in the treatment of hypertension in the patients of end-stage renal disease leading to hemodialysis: a retrospective study

Background: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients.Methods: A retrospective study was carried out on the patients who attended the hemodialysis unit of Hakeem Abdul Hamid Centenary hospital from July 2015 to June 2016 (one year), data on antihypertensive drugs and blood pressure control (pre-dialysis and post-dialysis) were recorded and analyzed.Results: 68.75% patients on hemodialysis were suffering from hypertension and were on antihypertensive medication. A combination of Amlodipine and clonidine were the most frequently prescribed antihypertensive agents. Muscle cramps an acute rise in blood pressure and hypotension were the most frequently encountered intradialytic complications in these patients.Conclusions: Although a combination of amlodipine and clonidine was most frequently prescribed antihypertensive medication in these patients these drugs were associated with intradialytic complications like muscle cramps and hypotension. Amlodipine with beta-adrenoceptor blocker (metoprolol or bisoprolol) provided best control of blood pressure in these patients with least intradialytic complications.

Hypertension in the Neonatal Period: An Update.

There has been a growing interest among neonatologists and paediatricians regarding identification and evaluation of hypertension in the neonatal period. Despite the emergent normative data on blood pressure values in term and preterm neonates over the last two decades, there is still controversy regarding correct definition and classification of hypertension. This article will discuss the current definitions, available normative data and etiology of neonatal hypertension. There is paucity of records in terms of efficacy of antihypertensive drugs in this specific population and management is usually experience based, causing considerable heterogeneity amongst different units. This review article will also cover the evaluation, management, outcomes and follow up of neonatal hypertension with latest advances in this field.

Pharmacogenetic approaches to predicting the efficiency and safety of amlodipine in patients with arterial hypertension

An open, non-comparative, prospective clinical study was conducted to evaluate the antihypertensive efficacy and tolerability of amlodipine, a calcium antagonist, in patients with arterial hypertension (AH) I-II stages, depending on the genotype for the polymorphic marker C3435T of the ABCB1 gene. The study included 100 patients with AH I-II stages, aged from 45 to 58 years. The initial dose of amlodipine was 5 mg, duration of treatment was 12 weeks. General clinical examination methods, office measurement and daily blood pressure monitoring, tolerance evaluation, and genotyping using the ABCB1 polymorphic marker C3435T by the PCR-RFLP method (polymerase chain reaction and restriction fragment length polymorphism) were used. The statistical analysis of results was carried out using the Mann-Whitney U test for quantitative variables, Kruskal-Wallis one-way analysis of variance (ANOVA) for three independent groups of quantitative data. Excellent antihypertensive efficacy with the CC genotype was found in 11.8% patients, with CT - 33.9%, with TT - 43.3%; good - 35.3%, 32.1%, and 33.3% respectively, satisfactory - 52.9%, 34,0% and 23.4% respectively. Six patients with the CT genotype and nine patients with the CC genotype required the increase in the dose to 10 mg. The number of patients with Adverse drug reactions (ADR) were found in 35.3% of patients with the CC genotype, 6.7% with the TT genotype and 11.3% with the CT genotype. The Kruskal-Wallis test revealed significant differences between CC and TT genotypes in the degree of decrease in SBP (p=0.02), antihypertensive efficacy parameter (p=0.02), an increase in dose requirements (p = 0.04) and the incidence of ADR(p=0.05). In AH patients (I-II stage) with the TT genotype of the C3435T gene polymorphism one can expect higher rates of antihypertensive efficacy of amlodipine in combination with a good safety profile and the lowest ADR percentage, while patients with the CC genotype more likely to develop ADR and lower antihypertensive responsiveness.

Блокатор рецепторов ангиотензина телмисартан: эффективность, безопасность и актуальность клинического применения

Angiotensin receptor blocker telmisartan is a modern and effective antihypertensive drug which has advantages in comparison with other drugs of the group of angiotensin receptor blockers. Long half-life retains its effect is significant more than 24 hours, which is especially important for blood pressure control in the dangerous morning hours. Telmisartan is excreted by the kidneys less than 2%, making its use safe in patients with renal pathology. High antihypertensive efficacy combined with its excellent tolerability. Telmisartan has the greatest affinity to PPARg-receptors, which is especially important when selecting antihypertensive therapy in patients with arterial hypertension and metabolic disorders, insulin resistance, metabolic disorders. A considerable number of studies showing the effectiveness of treatment with telmisartan in patients with cardiovascular disease, diabetes, metabolic syndrome, nephropathy. The article presents the results of a study of therapeutic equivalence of generic drug is telmisartan, which showed a high bioequivalence to original brand-name formulation and was according to the indications: hypertension and decrease cardiovascular morbidity and mortality in patients aged 55 years and older with a high risk of cardiovascular disease. The results of our observations show comparable antihypertensive efficacy of the original and generic products and well tolerated by the results of questioning of patients.

COMBINATION ANTIHYPERTENSION THERAPY: TRIPLE FIXED COMBINATION OF ANTIHYPERTENSIVE DRUGS

The article presents modern view on the role of combination antihypertension therapy in treatment of arterial hypertension. The benefits of fixed combinations are shown, rational combinations described for three antihypertensive medications. The results of investigations provided witnessing the increase of efficacy of antihypertension therapy with addition of a third drug. The antihypertension efficacy is studied, as safety, and clinical situations on prescription of perindopril/ indapamide/amlodipine combination.

Efficacy of Various Antihypertensive Drugs in the Treatment of Hypertension in the Patients of End-Stage Renal Disease Leading to Haemodialysis- A Retrospective Study

Introduction: Cardiovascular complications are the leading cause of morbidity and mortality in the patients of end-stage renal disease leading to hemodialysis. Majority of these patients suffers from hypertension and adequate control of blood pressure is a challenge in these patients because of multifactorial etiology and complicated pharmacokinetic changes in these patients. The present study aims is to find out the best possible drug or combination of drugs that can provide better control of blood pressure and improve the quality of life of these patients. Methodology: A retrospective study was carried out on the patients who attended the Haemodialysis unit of Hakeem Abdul Hamid Centenary hospital from July 2015 to June-2016 (one year), data on antihypertensive drugs and blood pressure control (pre-dialysis and post-dialysis) were recorded and analyzed. Result: 68.75% patients on haemodialysis were suffering from hypertension and were on antihypertensive medication. A combination of amlodipine and clonidine were the most frequently prescribed antihypertensive agents. Muscle cramps an acute rise in blood pressure and hypotension were the most frequently encountered intradialytic complications in these patients. Conclusion: Although a combination of Amlodipine and Clonidine was most frequently prescribed antihypertensive medication in these patients these drugs were associated with intradialytic complications like muscle cramps and hypotension. Amlodipine with beta-adrenoceptor blocker (metoprolol or bisoprolol) provided best control of blood pressure in these patients with least intradialytic complications.

Efficacy and Tolerability of Antihypertensive Drugs in Diabetic and Nondiabetic Patients.

Objectives of the Study:The aim of the study was to compare the efficacy and tolerability of different classes of antihypertensive drugs in diabetic and nondiabetic patients (NDPs) with essential hypertension.Material and Methods:The study was conducted in Mayo Hospital, Punjab Institute of Cardiology, and National Defence Hospital, Lahore, Pakistan, on 200 hypertensive patients with diabetes and 230 hypertensive patients without (Three hospitals) diabetes. Both male and female patients of age between 30 and 80 years with systolic blood pressure (SBP) above 130 mmHg and diastolic blood pressure (DBP) above 80 mmHg were enrolled in the study. Angiotensin converting enzyme inhibitors (ACEI), beta-blocker (βB), calcium-channel blocker (CCB), diuretics (D), angiotensin receptor blocker (ARB) as well as α-blocker classes of antihypertensive drugs were used. These drugs were used as monotherapy as well as combination therapy. The study was conducted for 4 months (July–October). After 4 months, patients were assessed for efficacy by monitoring blood pressure (BP) and tolerability by assessing safety profile on renal function, liver function as well as lipid profile.Results:Significant control in mean BP by all drug groups was observed in “both groups that is patients with diabetes and without diabetes.” The efficacy and tolerability data revealed that in diabetic patients with hypertension, the highest decrease in SBP and DBP was observed using monotherapy with ACEI, two-drug combination therapy with ACEI plus diuretic, ARBs plus diuretic, ACEI plus CCBs, three-drug combination therapy with ACEI plus CCBs plus diuretic, and four drug combination therapy with ACEI plus CCBs plus diuretic plus βBs, ARB's plus CCBs plus diuretic plus βBs while in NDPs, monotherapy with diuretic, two-drug combination therapy with ACEI plus CCBs, ACEI plus βBs, three-drug combination therapy with βBs plus ACEI plus D was found more effective in controlling SBP as well as DBP. Adverse effects observed were dry cough, pedal edema, dizziness, muscular cramps, constipation, palpitations, sweating, vertigo, tinnitus, paresthesia, and sexual dysfunction.Conclusion:All classes of antihypertensives were found to control blood pressure significantly in both groups of patients that is diabetic patients with hypertesion and non-diabetic patients with hypertension.

Преимущества азилсартана медоксомила у пациентов с артериальной гипертонией: как правильно осуществить выбор и оптимизировать антигипертензивную терапию?

Azilsartan medoxomil is a drug from class of angiotensin II receptor antagonist (sartans), have a antihypertensive effect and excellent tolerability profile. In comparison with other drugs (candesartan, olmesartan, ramipril, chlorthalidone, valsartan) according to comparative studies and meta-analyses azilsartan medoxomil demonstrated high antihypertensive efficacy, in terms of 24-hour BP control, which allows to recommend its purpose in patients of hypertension 1-2 degrees. This is due to the ability of the drug not only safely reduce AD during day and night hours, but also to normalize the circadian profile. Pleiotropic effects of azilsartan medoxomil in the form of increased sensitivity of receptors to insulin, a positive effect on glucose metabolism, improved endothelial function allow us to consider its purpose in patients with carbohydrate metabolism disorders, overweight, obesity, and metabolic syndrome. The drug is indicated for as patients who have not previously received antihypertensive therapy and if previous treatment with other RAAS blockers did not lead to reliable achievement of target BP levels. High efficiency and safety of azilsartan medoxomil can provide better patient adherence to long term therapy and achieve optimal results of therapy.

Effect of different drug classes on reverse remodeling of intramural coronary arterioles in the spontaneously hypertensive rat

Symptoms and signs of myocardial ischemia in the absence of obstructive coronary disease are common in hypertensive patients. This can be explained by CMD due to adverse remodeling of coronary arterioles which have also been reported in the SHR. The aim of this study was to compare the effects of ramipril, perindopril, candesartan, atenolol, amlodipine, indapamide, and HMR1766 on CMD in the SHR. Eight groups of 24-wk-old SHR were treated for 8wk. BP was measured invasively at the end of the treatment. After sacrifice, hearts were mounted on a Langendorff apparatus for the measurement of hyperemic CF. Hearts were then processed for histomorphometric analysis. All compounds, except HMR1766, induced a significant reduction in BP. Perindopril and candesartan increased hyperemic CF, whereas the other compounds had no significant effect. Perindopril, ramipril, atenolol, indapamide, and HMR1766 induced significant reverse arteriolar remodeling, whereas candesartan and amlodipine did not. The effect of antihypertensive treatment on CMD is not exclusively dependent on BP reduction. Compounds with comparable antihypertensive efficacy may exert different effects on CF and induce different degrees of reverse arteriolar remodeling.

Biochemical parameters as indicators of antihypertensive efficacy of leaf aqueous extract of Tridax procumbens (Lin) in L-NAME induced hypertensive rats

Abstract Background: Cardiovascular disease is a widespread public health problem and hypertension is one of the major risk factor. Tridax procumbens leaf extract is traditionally used in the treatment of hypertension. This study evaluate the effects of Tridax procumbens extract (TPE) on blood biochemical parameters of N-nitro-L-arginine methyl ester (L-NAME) induced hypertensive rats. Materials and Methods: Rats were divided randomly into four different treatment groups. Group I received 0.9 % NaCl (Control), Group II, III and IV were given a NOS inhibitor (L-NAME) 40 mg/kg/day, orally for 6 weeks to induce hypertension. Groups III and IV were further treated with TPE (100 and 200 mg/kg/day) respectively in the last 3 weeks of 6 weeks. Blood pressure, morphological variables, histopathology, plasma lipids, lipoproteins and cholesterol levels, hepatic enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST) and other parameters were analyzed. Results TPE markedly inhibited the sustenance of L-NAME-induced hypertension. This effect was accompanied by a partial or full amelioration of most of the adverse effects induced by L-NAME, such as: (1) increases in blood pressure, organs weight indices; (2) hyperlipidemia; (3) increased plasma activity of glutamic-pyruvic transaminase (ALT) and AST (4) liver and cardiac histological lesions. Conclusions This study provides evidence about the antihypertensive effects and end-organ protection of Tridax procumbens extract in animal model of hypertension. These effects may be due to one or more constitution in this extract

Antihypertensive Effects of Roselle-Olive Combination in L-NAME-Induced Hypertensive Rats.

This study aimed to evaluate the antihypertensive efficacy of a new combination therapy of Hibiscus sabdariffa and Olea europaea extracts (2 : 1; Roselle-Olive), using N(G)-nitro-L-arginine-methyl ester- (L-NAME-) induced hypertensive model. Rats received L-NAME (50 mg/kg/day, orally) for 4 weeks. Concurrent treatment with Roselle-Olive (500, 250, and 125 mg/kg/day for 4 weeks) resulted in a dose-dependent decrease in both systolic and diastolic blood pressure, reversed the L-NAME-induced suppression in serum nitric oxide (NO), and improved liver and kidney markers, lipid profile, and oxidative status. Furthermore, Roselle-Olive significantly lowered the elevated angiotensin-converting enzyme activity (ACE) and showed a marked genoprotective effect against oxidative DNA damage in hypertensive rats. Roselle-Olive ameliorated kidney and heart lesions and reduced aortic media thickness. Real-time PCR and immunohistochemistry showed an enhanced endothelial nitric oxide synthase (eNOS) gene and protein expression in both heart and kidney of Roselle-Olive-treated rats. To conclude, our data revealed that Roselle-Olive is an effective combination in which H. sabdariffa and O. europaea synergistically act to control hypertension. These effects are likely to be mediated by antioxidant and genoprotective actions, ACE inhibition, and eNOS upregulation by Roselle-Olive constituents. These findings provide evidences that Roselle-Olive combination affords efficient antihypertensive effect with a broad end-organ protective influence.

Multicenter Randomized Double-Blind Comparison of Nebivolol plus HCTZ and Irbesartan plus HCTZ in the Treatment of Isolated Systolic Hypertension in Elderly Patients: Results of the NEHIS Study

The present study was aimed at comparing the antihypertensive efficacy, tolerability, and side effects profile of nebivolol/hydrochlorothiazide (NH) vs irbesartan/hydrochlorothiazide (IH) combination in elderly patients with isolated systolic hypertension (ISH). 124 ISH patients aged 69.1±5.1years (mean±SD) were enrolled by 13 general practitioners in Netherlands and Belgium and randomized in a double-blind fashion to receive either NH (5/12.5 mgday, n=62) or IH (150/12.5mgday, n=62) for a 12-week period. The primary efficacy endpoint of the study was the comparison of the two combinations in terms of sitting office systolic blood pressure (BP) reduction after 12weeks of treatment. In addition ambulatory BP, 24-h BP variability, tolerability, and safety profile were also investigated. 122 patients were included in the intention-to-treat analysis. After 12weeks of treatment the reduction of systolic BP with NH was significantly greater than IH (-25.8±12 vs -21.2±14mm Hg, P<0.03). Diastolic BP reduction was significantly greater with NH after 4 and 8weeks of treatment but similar at the end of the study (or after 12weeks). In contrast, the magnitude of the 24-h, daytime, and nighttime systolic and diastolic BP reduction was almost similar in the two groups, while heart rate reduction induced by NH was significantly (P<0.001) greater during the 24-h, daytime, and nighttime period than that induced by IH. NH caused a reduction in 24-h BP variability significantly greater than IH (standard deviation -4.4±2.7 vs -2.2±5.1mm Hg, P<0.02, variation coefficient -2.0±2.6 vs -0.3±3.4%, P<0.01). Both treatment regimens were well tolerated. These data provide evidence that NH reduces office BP more than IH but has similar effects on 24-h BP. NH reduces 24-h systolic and diastolic BP variability more than IH, suggesting a greater protective effect on a variable known to adversely affect prognosis. EU clinical Trials Register identifier, 2010-023104-28. Menarini International Operations Luxembourg.

GW27-e0257 Effectiveness and metabolic effects of combination antihypertension therapy in hypertension: A systematic review

Systematic review the effects of renin-angiotensin system inhibitors plus calcium channel blockers(RC) and renin-angiotensin system inhibitors plus thiazide diuretics(RD) on antihypertensive efficacy, carbohydrate metabolism, lipid metabolism, electrolyte and renal function in patients with primary

Lercanidipine effect on circulating CD34+ progenitor cells in elderly patients: a randomized study

Objective: This randomized study evaluates the effects of lercanidipine – as well as its antihypertensive efficacy – on the number of circulating endothelial progenitor cells (EPCs) in elderly patients with hypertension.Research design and methods: In total, 61 patients with hypertension were randomly assigned to lercanidipine 10 mg/day or to other antihypertensive treatments (control group).Main outcome measures: Cytometry analysis was conducted at baseline, at 12 weeks and at 24 weeks. Routine clinical examination was also performed.Results: Overall, the number of circulating EPCs had already significantly increased with lercanidipine, compared with baseline values, after 12 weeks; this increase was sustained until the end of the study. On the other hand, the number of circulating EPCs remained stable in the control group throughout the study period. At 12 weeks, a significant reduction in blood pressure, compared with baseline values, was observed in both groups. Regression analysis showed a significant negative correlation between systolic blood pressure and the number of circulating EPCs.Conclusions: Although the limited number of patients and the short follow-up hamper the analysis, this study suggests that lercanidipine may increase EPC concentration independently from its anti-hypertensive effect.

Leg edema with (S)-amlodipine vs conventional amlodipine given in triple therapy for hypertension: a randomized double blind controlled clinical trial.

BackgroundLeg edema is a common adverse effect of dihydropyridine Calcium Channel Blockers (CCB) that may need dose reduction or drug withdrawal, adversely affecting the antihypertensive efficacy. Leg edema is reported to occur less often with (S)-amlodipine compared to conventional racemic amlodipine. We aimed to find the incidence of leg edema as a primary outcome and antihypertensive efficacy with (S)-amlodipine compared to conventional amlodipine.MethodsThis prospective, double-blind, controlled clinical trial randomized 172 hypertensive patients, not controlled on beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), to either conventional amlodipine (5–10 mg; n = 86) or (S)-amlodipine (2.5–5 mg; n = 86), while continuing their previous anti-hypertensive medications. Sample was sufficient to find a difference in edema between the interventions with 80 % power at 5 % significance level. Intension to treat analysis (ITT) for safety data and per protocol analysis for efficacy data was performed. Fischer’s exact test was applied to observe difference between responder rates and proportions of subjects having peripheral edema in the two groups. Pitting edema test scores were compared using Mann–Whitney test.ResultsAltogether 146 patients (amlodipine, n = 76 and (S)-amlodipine, n = 70) completed 120 days treatment. Demographic variables and treatment adherence were comparable in the two groups. Incidence of new edema after randomization was 31.40 % in test group and 46.51 % in control group [p = 0.03; absolute risk reduction (ARR) = 15.1 %; Number Needed to Treat (NNT) = 7, ITT analysis]. Pitting edema score and patient rated edema score increased significantly in the control compared to test group (p = 0.038 and 0.036 respectively) after treatment period. Edema scores increased significantly in the control group from baseline (p < 0.0001). Responders in blood pressure were 98.57 % in test and 98.68 % in control group. Most common adverse events (AE) were pitting edema and increased urinary frequency. Incidence of all AEs other than edema was similar in both groups. Two serious AEs occurred unrelated to therapy. Biochemical and ECG parameters in the two groups were comparable.ConclusionsIn hypertensive patients not controlled on prior BB and ACEI/ARB therapy, addition of (S)-amlodipine besylate at half the dose of conventional amlodipine provides better tolerability with reduced incidence of peripheral edema, and equal antihypertensive efficacy compared to amlodipine given at usual doses.Trial registrationSri Lanka Clinical Trials registry: www.slctr.lk, SLCTR/2013/006

PP.13.19] MONOTHERAPY WITH RILMENIDINE PRODUCES AN EFFECTIVE BLOOD PRESSURE CONTROL AND IMPROVES ECHOCARDIOGRAPHIC VARIABLES IN YOUNG MILD TO MODERATE HYPERTENSIVES

Objective: Rilmenidine is a new centrally acting antihypertensive agent with selective agonist activity at imidazoline I1 receptors from the brain with less adverse effects than other centrally acting sympatholytic drugs. In previous studies, Rilmenidine proved effective antihypertensive efficacy regardless of the age of patients. It is especially effective in patients with sympathetic overstimulation. The aim of this study was to evaluate the antihypertensive efficacy of rilmenidine and its effects on left ventricular hypertrophy and diastolic function in young patients with mild to moderate hypertension. Design and method: We performed a prospective study, lasting 3 months, in which 42 patients younger than 55 years old, (medium age 47.9 ± 5.6years), received once a day 1 mg rilmenidine. Diastolic left ventricular function was assessed by the following Doppler parameters: early (E) and late (A) peak velocities, E/A ratio, isovolumic relaxation time (IVRT), and deceleration time of E velocity (DT). Left ventricular mass index (LVMI) and diastolic function were determined at baseline and after 3 months. Blood pressure and heart rate were monitored at baseline and every month. Patients were requested to subjectively estimate their state as excellent, good, satisfactory and unsatisfactory. Results: After 3 months of therapy, systolic BP was reduced from 157.9 ± 13.6 mmHg to 130.1 ± 11.4 mmHg (p < 0.005) and diastolic BP from 97.6 ± 6.8 mmHg to 82.6 ± 6.7 mmHg (p < 0.005). Heart rate was reduced from 86.4 ± 6.6 bpm to 71.2 ± 4.4 bpm. LVMI decreased from 131.5 ± 3.5 g/m2 to 113.4 ± 3.6 g/m2 (p < 0.001). E/A ratio increased from 0.86 ± 0.24 to 1.02 ± 0.14 (p < 0.002). IVRT decreased from 118 ± 11 ms to 98 ± 10 ms (p < 0.001) and DT decreased from 216 ± 21 ms to 187 ± 17 ms (p < 0.002). 83.3% from the patients were controlled after 3 months of therapy. Treatment was well tolerated. None of the hypertensives estimated his state as unsatisfactory. Conclusions: Rilmenidine can be regarded as an effective and safe therapeutic possibility in mild/moderate young hypertensives. Therapy with Rilmenidine proved a good control of blood pressure, rich the therapeutic target, and was accompanied by the regression of cardiac hypertrophy and improvement in left ventricular diastolic function.

PS 14-39 ROLE OF THE TRIPLE COMBINATION WITH INDAPAMIDE, NITRENDIPINE AND PERINDOPRIL IN RENAL PROTECTION

Objective: To study of antihypertensive and renoprotective efficacy of indapamide, nitrendipine and perindopril combination therapy in hypertensive patients with low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Design and Method: The study included 20 patients with II-III stage of essential hypertension (ESH/ESC 2013) and eGFR<60 ml/min/1.73 m2 in average age 60.17 ± 7.86 yrs. All patients were resistant to previously bi-component antihypertensive therapy. Blood pressure (BP) measured by Korotkov method. GFR estimated by MDRD formula. Levels of serum creatinine, uric acid and glucose were measured with biochemical assay method. All measurements performed before and after 24 weeks of triple combination, based on indapamide, perindopril and nitrendipine in average dose 2.15 ± 0.56 mg, 4.72 ± 1.79 mg and 12.77 ± 5.65 mg respectively. Results: During the 24 weekly antihypertensive therapy with three drug combination systolic BP decreased from 160.0 ± 15.81 to 127.3 ± 11.8 mmHg (p = 0.0001), and diastolic BP – from 98.94 ± 8.11 to 79.3 ± 6.24 mmHg (p = 0.0001). Serum creatinine level was significantly decrease from 110.59 ± 20.69 to 93.4 ± 19.67 μmol/L (p = 0.01). Plasma glucose and uric acid levels had tendency to decrease: from 5.77 ± 1.16 to 5.71 ± 1.56 mmol/L and from 6.36 ± 1.99 to 5.76 ± 1.78 mg/dL (p > 0.05) respectively. eGFR was improved during the 24 weekly treatment and increased from 51.04 ± 6.81 to 62.58 ± 13.12 ml/min/1.73 m2 (p = 0.003), eGFR elevated >60 ml/min/1.73 m2 in 50% cases. All patients finished 24-weekly therapy with good tolerability. Conclusions: 24-weekly therapy with indapamide, perindopril and nitrendipine were characterized with high antihypertensive efficacy and good tolerability. Three drugs combination also had shown renoprotective effects with significantly increase of eGFR in hypertensive patients.

PP.05.13] AZILSARTAN MEDOXOMIL PROPORTIONALLY DECREASES CENTRAL AND BRACHIAL 24-H AMBULATORY BLOOD PRESSURE IN DIABETIC PATIENTS WITH DIFFICULT-TO-CONTROL ARTERIAL HYPERTENSION

Objective: Ambulatory monitoring of central blood pressure (BP) and arterial stiffness is a new technique for evaluation of antihypertensive drugs efficacy. The aim of the study was to assess changes in ambulatory brachial and central BP and AIx after azilsartan medoxomil (AM) 40 mg adjunction to treatment regimen in hypertensive type 2 diabetic patients. Design and method: AM 40 mg was given as substitution drug to ACEi to 20 hypertensive patients (8 male, age 58 + 10 years) with clinic BP >140/90 mmHg, 24-h BP >130/80 mmHg and/or daytime BP>135/85 mmHg previously treated with an ACEI and a second drug from another class. ABPM was done with BPLab VASOTENS (OOO Petr Telegin, Nizhniy Novgorod, Russia). Brachial and aortic BP changes as well as changes in 24-h, day- and nighttime AIx were evaluated. p < 0,05 was considered significant. Results: Significant (p < 0,05 vs baseline) decrease in 24-h, day- and nighttime BP after 4 weeks of Azilsartani medoxomil adjunction was observed: for brachial SBP, respectively, from 150 + 10 to 134 + 8, from 150 + 10 to 134 + 10, from 148 + 15 to 132 + 12 mmHg, for brachial pulse pressure (PP) from 54 + 10 to 48 + 9, from 54 + 8 to 46 + 8, from 56 + 10 to 48 + 7 mmHg. For aortic SBP corresponding changes were from 139 + 10 to 126 + 9, from 140 + 10 to 126 + 8, from 138 + 12 to 128 + 10 mmHg, for aortic PP, respectively, 46 + 6 to 38 + 5, from 44 + 6 to 36 + 8, from 46 + 7 to 38 + 6 mmHg. AIxHR75 bpm decreased at daytime from 28,3 + 12,6 to 21,7 + 10,1%, at night-time from 32,2 + 10 to 26 + 9%. Increase in PP amplification was observed also and was more evident in nighttime: baseline difference between brachial and aortic PP was 10,0 + 3,2 for daytime, 10,0 + 3,2 mmHg for nighttime, after azilsartan medoxomili treatment 10,7 + 2,6 and 10,2 + 2,8 mmHg, respectively (p < 0,05). Conclusions: Azilsartan medoxomil decreases significantly either brachial or aortic SBP and PP, as well decreases aortic PP augmentation. In hypertensive diabetic patient PP amplification was similar at day- and nighttime before and after treatment meaning proportional decrease of brachial and central SBP and PP.

PP.01.29] ASSESSMENT OF UNCOMPLICATED HYPERTENSION THERAPY EFFECTIVENESS IN REAL LIFE SETTING

Objective: Our aim was to compare the home blood pressure (BP) monitoring (HBPM) results with those obtained by ambulatory BP monitoring (ABPM) and office BP measurements before and after 6 month (M) algorithmic antihypertensive treatment of uncomplicated hypertension (UH) in longitudinal real-life BP control program. Design and method: We analyzed BP measurement results of 76 consecutively recruited patients (pts) 55,7 ± 9,8 years, with new diagnosed (13,1%) or treated but uncontrolled UH, participants of PERFECT-BP prospective observational study (ISRCTN75706523). Pts were prescribed or switched to perindopril/amlodipine FDC with successively adding, if needed, indapamid-SR, spironolactone, moxonidine or doxasosine. ABPM was performed within 2 days after visit 1 and before visit at M6. A validated oscillometric device Microlife BP3AG1 with individually selected cuff were used for HBPM (three times in the morning and evening for 7 consecutive days after visit 1 and before visit at M6). Office BP measurements were performed with standardized automatic Microlife BPW200 with universal cuff. Pearson's linear correlation was used for analysis. Results: By M6 office systolic BP (SBP) lowered from 164,9 ± 1,6 to 134,2 ± 1,3 mmHg; diastolic BP (DBP) – from 98,1 ± 0,9 to 83,2 ± 0,9 mmHg; home SBP – from 146,2 ± 1,6 to 131,6 ± 1,0 mmHg; DBP – from 91,3 ± 1,1 to 82,7 ± 0,8 mmHg; 24-hour SBP – from 150 ± 1,8 to 129,7 ± 1,2 mmHg; DBP - from 91,2 ± 1,2 to 81,4 ± 1,2 mmHg; daytime SBP – from 154,9 ± 2,3 to 134,0 ± 1,7 mmHg; DBP– from 95,3 ± 1,5 to 84,3 ± 1,2 mmHg; (all p < 0,001). HBPM showed a good correlation with office BP measurements and ABPM results at baseline and by M6 both for SBP and DBP (see in table). Masked hypertension at M6 was identified by ABPM in 17 (22,4%) and by HBPM in 19 (25%) pts (p > 0,05).Conclusions: HBPM is an acceptable tool for assessment of antihypertensive treatment efficacy for UH in real life setting.