Antihypertensive Therapy In Patients Research Articles

Resolution of the Council of Experts “The choice of antihypertensive therapy in patients with hypertension and obstructive sleep apnea syndrome”

On June 24, 2023, a meeting of the Council of Experts was held in videoconference mode with the support of Merck LLC, dedicated to the choice of antihypertensive therapy in patients with arterial hypertension and obstructive sleep apnea syndrome.

Comparison of two single-pill dual combination antihypertensive therapies in Chinese patients: a randomized, controlled trial

BackgroundCurrent hypertension guidelines recommend combination of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker with a calcium-channel blocker or thiazide diuretic as initial antihypertensive therapy in patients with monotherapy uncontrolled hypertension. However, to what extent these two different combinations are comparable in blood pressure (BP)-lowering efficacy and safety remains under investigation, especially in the Chinese population. We investigated the BP-lowering efficacy and safety of the amlodipine/benazepril and benazepril/hydrochlorothiazide dual therapies in Chinese patients.MethodsIn a multi-center, randomized, actively controlled, parallel-group trial, we enrolled patients with stage 1 or 2 hypertension from July 2018 to June 2021 in 20 hospitals and community health centers across China. Of the 894 screened patients, 560 eligible patients were randomly assigned to amlodipine/benazepril 5/10 mg (n = 282) or benazepril/hydrochlorothiazide 10/12.5 mg (n = 278), with 213 and 212 patients, respectively, who completed the study and had a valid repeat ambulatory BP recording during follow-up and were included in the efficacy analysis. The primary outcome was the change from baseline to 24 weeks of treatment in 24-h ambulatory systolic BP. Adverse events including symptoms and clinically significant changes in physical examinations and laboratory findings were recorded for safety analysis.ResultsIn the efficacy analysis (n = 425), the primary outcome, 24-h ambulatory systolic BP reduction, was − 13.8 ± 1.2 mmHg in the amlodipine/benazepril group and − 12.3 ± 1.2 mmHg in the benazepril/hydrochlorothiazide group, with a between-group difference of − 1.51 (p = 0.36) mmHg. The between-group differences for major secondary outcomes were − 1.47 (p = 0.18) in 24-h diastolic BP, − 2.86 (p = 0.13) and − 2.74 (p = 0.03) in daytime systolic and diastolic BP, and − 0.45 (p = 0.82) and − 0.93 (p = 0.44) in nighttime systolic and diastolic BP. In the safety analysis (n = 560), the incidence rate of dry cough was significantly lower in the amlodipine/benazepril group than in the benazepril/hydrochlorothiazide group (5.3% vs 10.1%, p = 0.04).ConclusionsThe amlodipine/benazepril and benazepril/hydrochlorothiazide dual therapies were comparable in ambulatory systolic BP lowering. The former combination, compared with the latter, had a greater BP-lowering effect in the daytime and a lower incidence rate of dry cough.Trial registrationClinicalTrials.gov, NCT03682692. Registered on 18 September 2018.

ВЛИЯНИЕ ГИПОТЕНЗИВНОЙ ТЕРАПИИ НА ПОКАЗАТЕЛИ ГЕМОДИНАМИКИ У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ В СОЧЕТАНИИ С РЕВМАТОИДНЫМ АРТРИТОМ

Introduction. The appointment of antihypertensive therapy in patients with comorbidity of primary hypertension and rheumatoid arthritis, considering the activity of rheumatoid arthritis is not always specified, and therefore is an urgent issue that may cause a discrepancy between the hemodynamic influence of the prescribed therapy and the nature of existing hemodynamic shifts in this category of patients. Aim. Impact evaluation of the 6-month antihypertensive therapy with drugs of various classes on the hemodynamic parameters of the circulatory system in patients with hypertension stage II combined with rheumatoid arthritis, including its activity. Material and methods. Patients complying the inclusion criteria by age (58.6±6.4 years), hypertension duration (11.2±1.6 years), debut (aged 45-64 years) and rheumatoid arthritis experience (7.2±2.1 years) were formed into three groups: Group I included 277 patients with hypertension stage II (136 men, 141 women); Group II consists of 142 patients (28 men, 114 women) with hypertension stage II and rheumatoid arthritis (in the stage of clinical and laboratory remission); and in Group III there were 112 patients (20 men, 92 women) with hypertension stage II and rheumatoid arthritis (in the stage of clinical and laboratory exacerbation). Antihypertensive therapy was administered by polyclinic physicians. Lisinopril, nebivolol, losartan, amlodipine, indapamide and an unfixed combination of lisinopril and indapamide were prescribed as monotherapy drugs. The follow up period has lasted for 6 months. Results and discussion. Effectiveness control of the prescribed therapy in 6 months was presented in patients in Groups I and II with positive dynamics of morphometric and velocity parameters, in patients in Group III, the indicators were less significant and more delayed. Conclusion. Rheumatoid arthritis presence adds additional changes in the dynamics of the hemodynamic influence of the prescribed antihypertensive therapy, and is determined by the activity degree of the disease and the adequacy of basic anti- inflammatory therapy.

Hemodynamic effects of antihypertensive therapy in patients with hypertension and rheumatoid arthritis comorbidity

Hemodynamic effects of antihypertensive therapy in patients with hypertension and rheumatoid arthritis comorbidity

“The impact of statins addind to the fixed combination antihypertensive therapy on the arterial stiffness in patients with moderate and severe hypertension"

AimThe objective of this study was the evaluation of the arterial stiffness, which changed after adding statins to the guidelines recommended dual or triple fixed combination antihypertensive therapy in patients with moderate to severe arterial hypertension. Materials and methodsIt was included 99 patients in total being diagnosed with moderate and severe arterial hypertension (2nd and 3rd stages of arterial hypertension) without diabetes. Those patients were divided into 2 groups. The first group (n = 59) was assigned to the dual or triple fixed combination antihypertensive therapy plus including statins.Patients in the second group (n = 40) received only the dual or triple fixed combination antihypertensive treatment following the recommended guidelines without any statins. The CAVI index was performed in order to measure in all participants before and at the end of the follow-up period. Furthermore, the Office (Clinic BP) Blood Pressure (BP) was monitored in assigned participants as well as the Ambulatory Blood Pressure Monitoring (ABPM). The laboratory investigations also took place such as the standard blood test, the urine and biochemistry analysis and the estimated Carotid Intima-Media Thicknesses with Ultrasound. The study-duration was 6 months. ResultsOffice BP and ABPM had decreased significantly and equally in both treatment groups. The total cholesterol (TC) and LDL cholesterol had decreased significantly in the statin group on 1,76 mmol/l (30%, p < 0,05) and 1,51 mmol/l (41%, p < 0,05) respectively. In the group without statin therapy, there was no changes in the level of TC and LDL cholesterol. In the group without statins, it was noted a significant decrease in the level of BP, however, the CAVI index level was shown the growth to +0,9 units on the right side and +1,0 units on the left.In the group without statin's treatment, the CAVI index was changed from 7.73 ± 0.17/7.62 ± 0.19 units to 8.63 ± 0.22/8.62 ± 0.12 units on the right/left site after treatment (p < 0,05). It means there was an increase in the stiffness of the arterial wall in terms of cardio-vascular index CAVI in the group without added statin after 6 months of the therapy. In the group with added statin after 6 months of the therapy, the CAVI had not have any changes. It can be seen from the observed figures: the CAVI on the right/left site was 8.32 ± 0.16/8.33 ± 0.19 initially and 8.44 ± 0.16/8.24 ± 0.15 units treatment (p > 0,05) afterwards.We did not note any impact of statin therapy on the BP level. However, a significant correlations was found between the CAVI index with age and the serum level of blood Triglycerides before treatment, including LDL Cholesterol and HDL Cholesterol, duration of hypertension, the blood glucose level, the Potassium level and the Maximum Thickness of Intima-Media of Carotid Arteries in the statins group. ConclusionThe adding of the statin to the current fixed dual or triple combination of the antihypertensive therapy could prevent the progression of arterial stiffness in patients with 2nd and 3rd stages of arterial hypertension.

Blood pressure lowering effects of β-blockers as add-on or combination therapy: A meta-analysis of randomized controlled trials.

The authors performed a meta-analysis to assess the efficacy of non-atenolol β-blockers as add-on to monotherapy or as a component of combination antihypertensive therapy in patients with hypertension. The authors searched and identified relevant randomized controlled trials from PubMed until November 2021. Studies comparing blood pressure lowering effects of β-blockers with diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) were included. The analysis included 20 studies with 5544 participants. β-blockers add-on to monotherapy significantly reduced systolic and diastolic blood pressure as compared with non-β-blocker monotherapy (weighted mean difference in mm Hg [95% confidence interval]: -4.1 [-6.0, -2.2] and -3.7 [-4.6, -2.8], respectively). These results were consistent across the comparisons with diuretics (systolic pressure, -10.2 [-14.2, -6.2]; diastolic pressure, -5.4 [-8.2, -2.6]), CCBs (systolic pressure, -4.1 [-7.1, -1.0]; diastolic pressure, -2.8 [-4.1, -1.5]), and ACEIs/ARBs (systolic pressure, -2.9 [-4.3, -1.5]; diastolic pressure, -4.2 [-5.0, -3.4]). There was no significant difference in blood pressure lowering effects between combinations with and without a β-blocker (systolic pressure, -1.3mm Hg [-5.8, 3.2]; diastolic pressure, -.3mm Hg [-2.7, 2.1]). Metoprolol add-on or combination therapy had a significantly greater blood pressure reduction than non-β-blocker therapy (systolic pressure, -3.6mm Hg [-5.9, -1.3]; diastolic pressure, -2.1mm Hg [-3.5, -.7]). In conclusion, non-atenolol β-blockers are effective in lowering blood pressure as add-on to monotherapy or as a component of combination antihypertensive therapy. In line with the current hypertension guideline recommendations, β-blockers can and should be used in combination with other antihypertensive drugs.

Pharmacoepidemiological analysis of antihypertensive therapy in older age groups with senile asthenia syndrome

To conduct a pharmacoepidemiological study to determine the characteristics of antihypertensive therapy in older patients with senile asthenia syndrome (SSA) and compliance of this therapy with modern clinical recommendations. The study included 146 patients diagnosed with stage I-III hypertension who underwent inpatient treatment in the therapeutic department of the Krasnoyarsk Regional Hospital for War Veterans, the subjects were divided into two groups. The first group included 55 elderly patients (WHO, 2012) with hypertension and SSA. The second group included 35 elderly patients (WHO, 2012) with hypertension and SSA. The comparison group consisted of 56 patients aged 60 to 84 years with hypertension without SSA. Evaluation of the pharmacotherapy was carried out based on extracts from the medical histories of inpatient patients. The most commonly taken groups of antihypertensive drugs in patients of older age groups with hypertension and SSA according to the study are diuretics and β-blockers. Diuretics were taken by 88.6% of elderly patients and 83.6% of senile patients. The main combinations of antihypertensive drugs in patients with hypertension and SSA were: a two-component scheme of combination of an ACE inhibitor and a diuretic, a three-component scheme of combination of an ACE inhibitor, a β-blocker and a diuretic, four-component schemes of combination of an ACE inhibitor, a β-blocker, a calcium channel blocker and a diuretic, as well as a combination of an angiotensin II receptor blocker, a β-blocker, calcium channel blocker and diuretic with combined medications. The prescribed antihypertensive therapy in patients of older age groups with hypertension and SSA in most cases is represented by a combination of several drugs. Many patients take three-component antihypertensive therapy regimens. There were no statistically significant differences between patients of older age groups with hypertension and SSA, as well as patients of older age groups with hypertension without SSA. Therefore, it can be concluded that the presence of senile asthenia syndrome does not affect the tactics of treatment of hypertension and regardless of the presence or presence of SSA, patients receive the same hypotensive therapy, which contradicts existing clinical guidelines.

N-[2-(5-metoksi-1H-indol-3-il)]acetamid može da koriguje arterijsku hipertenziju kod ljudi koji imaju problema sa spavanjem

Introduction. Sleep disturbance is a frequent complaint of patients suffering from arterial hypertension (AH) for a long time. A hidden and uncontrolled increase in blood pressure (BP) makes the course of physiological processes more difficult, disrupts the regulation of biological rhythms, and increases the risk of cardiovascular complications even with a short duration of AH. At the same time, chronic sleep disorders contribute to the development of hypertension, defining the role of a new socially significant risk factor. An important role in the pathogenesis of insomnia is played by a deficiency in melatonin (MT) synthesis, which negatively affects the cardiovascular system (CVS). Aim. The aim of the paper was to study the features of central and vascular hemodynamics in patients with the 1st degree AH and to evaluate the clinical effectiveness of antihypertensive therapy with synthetic analog of prolonged-release MT at the onset of the disease. Methods. Instrumental examination included registration of an electrocardiogram, office measurement of blood pressure with an automatic tonometer, non-invasive automatic blood pressure monitoring for 24 hours. The severity of insomnia was assessed by somnological questionnaires. Representatives of the 1st group (n = 34) took monotherapy with the ACE inhibitor ramipril, participants of the 2nd group (n = 33) took the ACE inhibitor ramipril in combination with a synthetic analogue of melatonin. Results. The results of a randomized open prospective study including 78 participants reveal the activity of the renin-angiotensin-aldosterone system (RAAS), hypersympathicotonia at night and desynchronosis due to a possible deficiency in the MT secretion. Pharmacological antihypertensive therapy with the addition of prolonged release MT analog was accompanied by a significant improvement in the clinical condition of hypertensive patients. Positive dynamics of indicators of systemic hemodynamics and functional arterial parameters of stiffness was noted. Conclusion. The article describes the probable benefits of melatonin as part of combination antihypertensive therapy in patients with early-stage hypertension and insomnia. Additional introduction of MT at the onset of the AN as a physiological regulator of circadian biological rhythms is substantiated.

АНТИГИПЕРТЕНЗИВНАЯ ТЕРАПИЯ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ В ПЕРИОД ПАНДЕМИИ COVID-19

Arterial hypertension and diabetes mellitus – established large risk factors for cardiovascular diseases associated with atherosclerosis – are among the most common comorbidities in patients with coronavirus infection. Each of the pathologies, and especially their combination increases the cardiovascular risk, and in case of SARS-Cov-2 infection, the risk of severe course of infection and mortality. The article discusses the mechanisms of mutual burden of coronavirus infection, arterial hypertension and diabetes mellitus, provides a new concept of activating the immune system in hypertension, considers modern approaches to antihypertensive therapy in patients with diabetes mellitus.

PS-R01-6: SUCCESSFUL ANTIHYPERTENSIVE TREATMENT USING SACUBITRIL/VALSARTAN ALONE IN A PATIENT WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

Obstructive sleep apnea syndrome (O-SAS) is one of the emerging non-communicable health hazards with high rates of morbidity and mortality. O-SAS is known to induce excessive activity of sympathetic nervous system and result in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first line therapy for O-SAS, its poor adherence induces resistant hypertension. Sacubitril/valsartan has a sympatho-inhibitory effect and may contribute to antihypertensive therapy in patients with O-SAS. We present a successful case of a 39-year-old male with O-SAS using sacubitril/valsartan alone. He visited our clinic with severe hypertension noted during a routine health checkup. He was a heavy drinker, resulted in high body mass index. His family members worried about his loud snoring and witnessed apnea during sleep. The polysomnography showed a markedly increased apnea-hypopnea index of 37, which led to a diagnosis of severe obstructive sleep apnea. At first, we started treatment with CPAP and azilsartan, but he stopped CPAP due to excessive drinking. Then, we switched azilsartan to sacubitril/valsartan, and succeeded in improving his blood pressure. This case indicates that sacubitril/valsartan may be an effective therapy for uncontrollable hypertenstion due to O-SAS even without CPAP.

Prognostic implication of left ventricular hypertrophy regression after antihypertensive therapy in patients with hypertension.

Left ventricular (LV) hypertrophy (LVH) in patients with hypertension is a significant risk factor for cardiovascular mortality and morbidity. However, the prognostic implication of LVH regression after antihypertensive therapy has not been clearly investigated. Patients who underwent echocardiography at the time of the diagnosis of hypertension and repeated echocardiography at an interval of 6-18 months were retrospectively identified. LVH was defined as LV mass index (LVMI) >115 g/m2 (men) and >95 g/m2 (women). LVH regression was defined as LVH at initial echocardiography with normal geometry or concentric LV remodeling at follow-up echocardiography. Cardiovascular mortality, hospitalization for heart failure (HHF), coronary revascularization, stroke, and aortic events were analyzed according to changes in LVMI and geometry. Of 1,872 patients, 44.7% (n = 837) had LVH at the time of diagnosis; among these, 30.7% showed LVH regression. The reduction in LVMI was associated with the reduction in BP, especially in those with LVH at baseline. During follow up (median, 50.4 months; interquartile range, 24.9-103.2 months), 68 patients died of cardiovascular causes, 127 had HHF, and 162 had vascular events (coronary revascularization, stroke, and aortic events). Persistent or newly developed LVH during antihypertensive therapy was a significant predictor of cardiovascular mortality and events, especially HHF. On multivariable analysis, women, diabetes, atrial fibrillation, coronary artery disease, larger LVMI and end-diastolic dimension, and less reduction in systolic BP were associated with persistent or newly developed LVH. LVH regression in patients with hypertension is associated with a reduction in cardiovascular events and can be used as a prognostic marker.

Analysis of lifestyle modifications and antihypertensive therapy in patients with arterial hypertension and chronic kidney disease (data from the national registry)

The aim is to study the characteristics and quality of drug therapy and recommendations for lifestyle changes in patients with chronic kidney disease and arterial hypertension and, separately, chronic kidney disease and resistant arterial hypertension, observed in primary health care.Materials and methods. The study was carried out on the basis of the AH registry data (N = 43133; 2005-2019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc).Results. Less than half of all patients reached the target SBP values. ACE inhibitors/ARBs were not prescribed as first-line antihypertensive therapy in 18% of patients with stage 3 CKD. ACE inhibitors were more often prescribed to men than women (70,6% and 66,5%), and ARBs (11,9% and 15,6%). The frequency of prescribing ACE inhibitors, thiazide and thiazide-like diuretics remained practically unchanged at GFR ≥ 60 and 60 ≥ GFR &lt; 30 ml/min/1,73m2, while the frequency of prescribing ARBs, CCBs, loop diuretics increased with a decrease in glomerular filtration rate. Approximately 60% of patients with hypertension were given advice on nutrition and normalization of body weight (among patients with obesity), about 50% — advice on physical activity and ~50% of smokers received advice on smoking cessation. In patients with hypertension and GFR below 60 ml/min/1,73m2, primary care physicians gave advice on lifestyle changes more often than patients with higher GFR. In men with hypertension and 3 stage CKD the incidence of coronary artery disease (2 times), CHF (1,5 times), the incidence of myocardial infarction in history (3,4 times), the incidence of stroke in history (1,9 times) higher than in women. The frequency of the presence of probable resistant hypertension increased up to 23,9% with a decrease of eGFR among patients with uncontrolled hypertension and up to 11% with controlled.Conclusion. For patients with hypertension and CKD, it is necessary to achieve target values of blood pressure, conduct drug therapy aimed at blocking the RAAS (ACE inhibitors /ARBs), select drugs from the CCB group and diuretics as second and third line therapy. In patients with resistant hypertension the addition mineralocorticoid receptor antagonists is necessary.

Clinical efficacy of combination therapy of arterial hypertension in patients with chronic glomerulonephritis with different blood pressure salt sensitivity

Arterial hypertension is the main factor in the progression of CKD of any etiology; therefore, effective antihypertensive therapy is a crucial task of healthcare practice. In this work, the authors aim to study the comparative effectiveness of various types of combined antihypertensive therapy in patients with different blood pressure salt sensitivity.

Additional effects of diosmin in the treatment of arterial hypertension in patients with impaired renal venous blood flow

Objective: to estimate of the effect of diosmin in complex antihypertensive therapy on renal function in patients with hypertension and impaired renal venous blood flow.Materials and methods: we observed 147 patients with hypertension aged 40.86±8.27 with signs of bilateral impairment of venous blood flow in the kidneys, which, depending on the amount of therapy, were divided into 2 groups and 2 subgroups. The comparison group consisted of 57 AH patients with unchanged venous blood flow in both kidneys.Results: in the presence of impaired venous blood flow in the renal veins, the use of additional administration of diosmin allows maintaining or improving the filtration capacity of the kidneys. Additional monitoring of patients with impaired venous blood flow in the kidneys is required to assess the effectiveness of antihypertensive therapy with individual drugs with and without venoactive agents.Conclusion: the additional inclusion of diosmin in the complex antihypertensive therapy of patients with arterial hypertension and impaired venous blood flow to the kidneys can preserve and improve kidney function with normalization of GFR.

Antihypertensive therapy in patients with concomitant chronic obstructive pulmonary disease

Objective. Evaluation of the effectiveness and safety of antihypertensive therapy with a fixed dose combination of amlodipine/indapamide in patients with hypertension (HTN) and chronic obstructive pulmonary disease (COPD).Design and methods. We conducted a non-randomized, open, single-center study, which included 74 comorbid patients (62 men, 12 women) with stage I–II HTN, grade 1–2 HTN, moderate cardiovascular risk and COPD (GOLD I–III). We also assessed respiratory function, the parameters of the microcirculatory bed, vascular stiffness, level of tumor necrosis factor α (TNF-α). For HTN, after the examination all patients were prescribed a fixed combination of amlodipine and indapamide (Arifam, Les Laboratoires Servier, France). The observation period was 6 months.Results. The study was completed by 58 patients who achieved blood pressure (BP values of 132,7 + 4,8 mm Hg), 54% patients took the initial dose of amlodipine/indapamide was 5/1,5 mg and in 46% patients, the dose of the drug was increased to 10/1,5 mg. After 6 months of treatment, a statistically significant increase in forced expiratory volume in 1st second (FEV1) was detected (p &lt; 0,05), decrease in the average linear velocity along the maximum velocity curve (p &lt; 0,05), Purcelo peripheral resistance index (p &lt; 0,05), pulse wave propagation velocity in the elastic arteries, which was increased at the beginning of the study (p &lt; 0,05), TNF-α (p &lt; 0,05).Conclusions. The administration of a fixed combination of amlodipine/indapamide in patients with COPD and HTN leads to the achievement of target BP levels, reduction of vascular stiffness, reduction in TNF-α level, improvement of microcirculatory blood flow. The combination is safe and well-tolerated.

Efficacy of Single-Pill, Triple Antihypertensive Therapy in Patients with Uncontrolled Hypertension: A Systematic Review and Meta-analysis.

Systemic arterial hypertension is the most common preventable risk factor for all causes of morbidity and mortality worldwide with a prevalence of 35-40% of the adults. Despite the wide variety of effective antihypertensive medications, most hypertensive patients remain uncontrolled. However, the combination of ACE inhibitor, diuretics, and calcium antagonist for the triple therapy in a single Pill Combination (SPC) is an efficient regimen in hypertension management. It is recommended by the ESH 2018 guideline, which offers better efficacy and compliance to treatment. To evaluate the efficacy of perindopril/indapamide/amlodipine single-pill combination in patients with uncontrolled hypertension. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL for relevant clinical trials. We conducted the risk of bias assessment using Cochrane's risk of bias tool. We performed the analysis of continuous data using mean difference (MD) and relative 95% confidence interval (CI), while dichotomous data were analyzed using risk ratio (RR) and relative 95% CI. We included the analysis of the following outcomes: systolic blood pressure (SBP), Diastolic blood pressure (DBP), Heart rate (HR), 24 h Ambulatory blood pressure monitoring (ABPM) for SBP, and 24 h ABPM for DBP. We included six clinical trials. We found that the triple therapy significantly reduces SBP by 24 mmHg (MD = - 24.65 [22.41, 26.89], (P < 0.01)), DBP by 12 mmHg (MD = 12.41 [11.53, 13.29], (P < 0.01)), 24-h ABPM for SBP by 14 mmHg (MD = 14.08 [9.10, 19.05], (P < 0.01)), and ABPM 24 h DBP by 7 mmHg (MD = 7.01 [5.37, 8.65], (P < 0.01)). We noted no significant difference of the single pill on heart rate (MD = 0.81 [- 0.04, 1.67], (P = 0.06). perindopril/indapamide/amlodipine is effective in reducing systolic and diastolic blood pressures by 24 and 12 mmHg respectively. Over 24 h, the combination reduced systolic and diastolic blood pressures by 14 and 7 mmHg respectively.

Efficacy of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease

Objective: to study the comparative efficacy and safety of the use of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease. Materials and methods: 85 patients with a verified diagnosis of arterial hypertension and chronic obstructive pulmonary disease were examined, the average age of patients was 60.9±1.1 years; 54% of men and 46% of women who were prescribed two variants of combination therapy (group A amlodipine/perindopril, group B amlodipine/valsartan). At the first visit and 6 weeks after the start of therapy, all patients underwent clinical, laboratory and instrumental examinations in accordance with the current protocols for the treatment of hypertension and chronic obstructive pulmonary disease, a daily blood pressure study, the frequency of depressive disorders was assessed on the Beck scale and the quality of life according to the SF-36 questionnaire. Results: the use of both antihypertensive regimens in comorbid patients was accompanied by comparable antihypertensive efficacy of therapy, contributed to the same statistically significant decrease in daily, day and night blood pressure indicators. The analysis of the indicators of the function of external respiration revealed the absence of negative dynamics of spirographic indicators in both groups. The use of both combinations of antihypertensive drugs contributed to the statistically identical recovery of both physical and mental components of the patient's quality of life. The improvement in the quality of life of comorbid patients was accompanied by a decrease in the manifestations of depressive disorders in the studied patients according to the Beck scale. The average score of the Beck scale in patients of group A before treatment was 11.6±0.97, against the background of therapy — 9.1±0.77, p &lt;0.001. In patients of group B, it decreased from 13.0±1.06 to 9.3±0.78, p &lt;0.001. Conclusion: the use of antihypertensive combined strategies amlodipine / perindopril and amlodipine / valsartan for the treatment of hypertension in patients with chronic obstructive pulmonary disease is characterized by comparable effectiveness of blood pressure control, which is confirmed by the data of daily monitoring of blood pressure. Effective control of blood pressure was accompanied by statistically significant (p&lt;0.001) positive dynamics of most indicators of the quality of life of patients in both study groups and the severity of manifestations of depression. Any of the studied combinations, which demonstrated comparable efficacy and tolerability in the study, can be recommended as the first step of antihypertensive therapy in patients with arterial hypertension in combination with chronic obstructive pulmonary disease.

Choice of optimal antihypertensive therapy in patients with diabetes mellitus type 2

Aim of the study: to develop personalized approaches to combined antihypertensive therapy in patients with type 2 diabetes mellitus and arterial hypertension, depending on the parameters of the daily blood pressure profile and heart rate variability.Material and methods. We examined 322 patients with type 2 diabetes and arterial hypertension who had not previously received antihypertensive drugs on a regular basis. At the first stage, patients were prescribed Perindopril 10 mg per day and Indapamide retard 1,5 mg per day. In the absence of reaching target blood pressure (BP) levels after 28 days, a third antihypertensive drug was added — Amlodipine 5 mg per day, followed by titration to 10 mg 1 r per day (group I) or a b-blocker — Carvedilol at a dose of 12,5 mg 2 r per day, also followed by titration up to 25 mg 2 r per day (group II). Daily monitoring of BP and ECG was carried out, the average daily heart rate (HR), circadian index (CI), as well as heart rate variability were determined.Results and its discussion. Patients with type 2 diabetes have a high variability of blood pressure throughout the day, high pulse blood pressure, as well as a rigid circadian profile of heart rate. The appointment of a standard two-component antihypertensive therapy, including Perindopril 10 mg and Indapamide retard 1,5 mg per day, allows reaching the target blood pressure only in 46% of patients. The addition of amlodipine or carvedilol significantly increases the effectiveness of therapy, allowing more than 80% of patients to achieve the target blood pressure. At the same time, the use of amlodipine leads to a greater extent to a decrease in pulse pressure, and the inclusion of carvedilol improves the circadian profile of blood pressure and heart rate, and has a positive effect on heart rate variability.

Antihypertensive therapy in patients with primary hyperparathyroidism: a single-center retrospective study

<h3></h3> Первичный гиперпаратиреоз (ПГПТ) ассоциирован с высокой частотой различных сердечно-сосудистых заболеваний, в частности артериальной гипертензии. На сегодняшний день стратегия выбора антигипертензивной терапии у пациентов с гиперкальциемией не отличается от таковой у пациентов с нормальной сывороточной концентрацией кальция, однако патогенетические механизмы развития артериальной гипертензии при ПГПТ предполагают возможное преимущество в достижении нормотонии при использовании антигипертензивных препаратов определенных групп. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить спектр антигипертензивных препаратов, применяемых у пациентов с ПГПТ. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Исследование проведено на базе ФГБУ «НМИЦ эндокринологии» Минздрава России в период с января 2017 г. по декабрь 2021 г. В исследование вошли пациенты, госпитализированные по поводу верифицированного ПГПТ. Всем пациентам проведено обследование и лечение согласно действующим стандартам оказания медицинской помощи и клиническим рекомендациям. <h3>РЕЗУЛЬТАТЫ</h3> В исследование включены 585 пациентов с ПГПТ, из них у 397 человек наблюдалась артериальная гипертензия. Пациенты разделены на четыре группы по количеству принимаемых антигипертензивных препаратов: группа А — без терапии, группа В — один препарат, группа С — два препарата, группа D — три препарата и более. Пациенты группы D были статистически значимо старше, имели более низкую скорость клубочковой фильтрации и более высокие показатели кальциемии, чем пациенты группы А. В когорте пациентов 40—55 лет без нарушения функции почек и патологии углеводного обмена данных закономерностей не было выявлено. При анализе лекарственных назначений установлено, что пациентам с артериальной гипертензией требовалась интенсификация лечения и смена антигипертензивных препаратов. <h3>ЗАКЛЮЧЕНИЕ</h3> В настоящем исследовании продемонстрирована ассоциация между гиперкальциемией и интенсивностью антигипертензивной терапии у пациентов с первичным гиперпаратиреозом, патогенетические основы которой требуют уточнения. Ряд препаратов могут иметь дополнительные преимущества при лечении пациентов с первичным гиперпаратиреозом, однако для верификации этих эффектов необходимы дальнейшие исследования.

ARTERIAL HYPERTENSION FOLLOWING COVID-19: A RETROSPECTIVE STUDY OF PATIENTS IN A CENTRAL EUROPEAN TERTIARY CARE CENTER.

SUMMARYThe aim of this study was to determine the frequency of newly verified or worsened existing hypertension in patients who had coronavirus 2019 (COVID-19). To be categorized as a COVID-19 patient, a positive reverse-transcription polymerase chain reaction test at a single point in time was required. The patients’ age, history, laboratory values and antihypertensive therapy of patients were recorded. In one year, 32 of 199 patients studied had either newly verified (15) or worsened existing (17) arterial hypertension. Among those patients, the median time from a verified infection to the onset of symptoms was 3 months. When the patients were divided into groups, 4 were in the acute, 11 in the sub-acute, 8 in the chronic and 9 in the “long COVID” group. Compared to the rest of the study population, patients presenting with arterial hypertension had significantly higher systolic (median 141 mmHg vs 130 mmHg, p<0.001) and diastolic (median 93 mmHg vs 80 mmHg, p<0.001) blood pressure and were significantly younger (median 51 vs 59 years, p 0.032). Arterial hypertension following COVID-19, either newly verified or worsened existing, is a relatively common occurrence (16% of our patient pool), indicating that more effort should be directed at evaluating the blood pressure values of patients following COVID-19.