Antihypertensive Therapy In Patients Research Articles

Elucidating the complex interplay between chronic kidney disease and hypertension.

Chronic kidney disease (CKD) and hypertension share a complex relationship, each exacerbating the progression of the other. CKD contributes to hypertension by decreasing renal function, leading to fluid retention and increased plasma volume, whereas hypertension exacerbates CKD by increasing glomerular pressure and causing renal damage. This review examines the intertwined nature of CKD and hypertension, exploring the factors driving hypertension in CKD and how hypertension accelerates CKD progression. It discusses the role of the renin-angiotensin system and inflammatory cytokines in this relationship, as well as the potential of blood pressure management to slow renal decline. While studies suggest that meticulous blood pressure control can help attenuate CKD progression, optimal management strategies remain unclear and require further investigation. This review also evaluates the evidence surrounding strict antihypertensive therapy in patients with CKD, considering both diabetic and non-diabetic cases. It recommends blood pressure targets based on CKD stage and presence of diabetes, emphasizing the importance of individualized treatment approaches. Renin-angiotensin system inhibitors are highlighted as a key pharmacological intervention due to their renal protective effects, particularly in patients with CKD with proteinuria. However, evidence regarding their efficacy in patients with CKD but without proteinuria is inconclusive. This review underscores the need for comprehensive approaches to effectively address the intertwined nature of CKD and hypertension and calls for further research to optimize clinical management strategies in this complex interplay.

Antihypertensive therapy in patients with arterial hypertension and concomitant diseases in real clinical practice (according to the National Registry of Arterial Hypertension, 2019-2022)

Arterial hypertension (AH) remains the leading risk factor associated with cardiovascular diseases (CVDs), cerebrovascular disease and chronic kidney disease. About 70% of patients with AH who are on monotherapy cannot achieve blood pressure (BP) targets, and therefore all quidelines for the management of AH have recently recommended prescribing combination therapy (PCT). In real clinical practice (RCP), there remains significant uncertainty in the effectiveness and rationality of therapy, despite the wide availability of antihypertensive drugs (AHD) and the presence of recommendations for a stepwise approach to prescribing combinations of specific groups of AHD in different clinical situations. Analyze the real ongoing antihypertensive therapy, including the PCT; international nonproprietary names of drugs and their dosages in RCP; compliance of therapy with clinical recommendations; changing trends in the PCT. An analysis was carried out of the data from the register of AH, the compliance of treatment in different clinical groups of patients and the achievement of BP and low-density lipoprotein cholesterol targets in the sample of 2019-2022 (n=5012). The prescription of AHD and achievement of targets values were assessed in accordance with current clinical guidelines for the management of AH and hypercholesterolemia. Data from 2010 (n=7782) and 2020 (n=3061) were analyzed to assess the dynamics of prescription of monotherapy and PCT. The greatest increase in the number of AHD was observed in patients with hypertension in combination with coronary heart disease, heart failure, and atrial fibrillation. In a small group of patients with hypertension without other CVDs, the recommended combinations of AHD were not prescribed; preference was given to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-adrenoblocker (β-AB). PCT mainly differed from the recommended combinations by the wider use of drugs from the β-AB group. The PCT of recommended drugs was highest in patients with hypertension and coronary artery disease - more than 90%, hypertension and heart failure in 56.2%, hypertension and atrial fibrillation - 33.3%, hypertension and chronic kidney desease - 19.6%. Achievement of BP and low-density lipoprotein cholesterol targets was insufficient in all analyzed groups. Among the international nonproprietary names of drugs, the most frequently prescribed are the following: bisoprolol, metoprolol, lisinopril, perindopril, losartan, spironolactone, amlodipine, torasemide, indapamide, hypochlorothiazide, moxonidine. The prescribed daily dosages were closer to the initial recommended ones. By 2020, the prescription of PCT with β-AB and a more uniform prescription of various combinations will come to the fore, while PCT in 2010 is characterized by the presence of one or two leaders combinations. The described features of prescribing AHD partially reproduce clinical recommendations for the management of AH. Differences in therapy provided in RCP may be associated with an attempt to intensify the treatment of hypertension in patients with other concomitant CVDs. At the same time, analysis of combinations and dosages of prescribed drugs suggests the presence of wide opportunities for further escalation of therapy. The presented data can provide insight into current patterns of antihypertensive therapy prescription in patients in RCP and lay the foundation for optimizing therapy in different categories hypertensive patients.

Original Moxonidine and Generics: Where is the Edge of Difference?

To compare the efficacy of adding original moxonidine and its generics to previous ineffective antihypertensive therapy in patients with poorly controlled arterial hypertension (AH). This observational prospective non-randomized study included 120 patients with poorly controlled blood pressure on the previous antihypertensive therapy. All patients underwent clinical evaluation, including anthropometric and laboratory indexes, and 24-hour blood pressure monitoring (24-h BPM) at baseline and after 12 weeks of observation. Office systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) were recorded after 4 and 12 weeks of treatment. During the observation period, 4 equal groups were formed: group 1, Physiotens was added to the treatment; group 2, Moxonitex; group 3, Moxonidine SZ; and group 4, Moxonidine Canon. Statistical analysis was performed with the StatTech v.4.2.7 software (© OOO StatTech, Russia). After 4 weeks of therapy, the BP target was achieved significantly more frequently in group 1 (63% of patients) compared to groups 2 (36.7% of patients), 3 (16.7% of patients), and 4 (16.7% of patients) (p<0.05). At 12 weeks, office SBP, DBP, and HR were significantly decreased in all groups, but the decrease was significantly greater in group 1. The therapy was associated with a more pronounced decrease in all studied 24-h BPM parameters in the Physiotens group than in other groups, as well as with a significantly more frequent normalization of the 24-h BP profile, in 66.7% of patients vs. 46.7%, 33.4%, and 23.2% of patients in groups 2, 3, and 4, respectively. The treatment with original moxonidine demonstrated advantages over generic drugs in terms of achieving the BP goal, reducing office BP and HR, and improving 24-h BPM parameters.

Assessment of the quality of life of patients suffering from chronic kidney disease depending on the clinical variability of the disease

This article describes in detail: features of the clinical course of the disease, assessment of quality of life, diagnostic criteria and modern classification of chronic kidney disease. Various pathogenesis of chronic kidney disease is revealed, taking into account the correspondence of the stages of chronic kidney disease to the ICD-10 coding. The article also details the modern methods of antihypertensive therapy in patients with chronic kidney disease, taking into account the latest clinical recommendations. Various modern studies of assessing the quality of life of patients using the SF-36 questionnaire are described, which includes 8 scales, namely: physical functioning (PF), role functioning due to physical condition (RFPC), pain intensity (PI), general health status (GHS), vital activity (VA), social functioning (SF), role functioning due to emotional state (RFES) and mental health (MH).

Adherence to the treatment in patients with hypertension during the war in Ukraine

Background. The aim of the study: to investigate additional factors that affect the adherence to antihypertensive therapy in patients with hypertension in conditions of war in Ukraine. Materials and methods. The study included 1,299 hypertensive patients with an average age of 65.4 ± 14.8 years, who are residents of different regions of Ukraine. The observation period lasted 3 months, from October 1 to December 12, 2023. All patients were divided into four groups: I — a fixed three-component combination of olmesartan medoxomil/amlodipine/hydrochlorothiazide, II — a fixed two-component combination of olmesartan/hydrochlorothiazide, III — a fixed two-component therapy with olmesartan/amlodipine, IV — any other non-fixed two- or three-component antihypertensive therapy. Adherence to therapy was assessed after 1, 2, and 3 months and statistical analysis of the obtained data was performed. Results. During the first month of observation, 50 (3.8 %) patients stopped or did not even start taking antihypertensive therapy, during the second — 71 (5.5 %), during the third — 127 (9.8 %). Adherence to antihypertensive therapy is higher in younger people (up to 55 years) compared to patients aged over 65, in people with higher education, in patients taking fixed combinations, especially olmesartan/amlodipine, or olmesartan/amlodi-pine/hydrochlorothiazide, while gender had no effect on adherence. Additional factors related to adherence to antihypertensive therapy during the war were as follows: the level of danger in the region of residence, the internally displaced status of the patient or doctor. The lowest adherence to antihypertensive therapy after 3 months was registered in the internally displaced persons who suffered morally or physically and is only 34.5 % compared to patients who stayed in the place of permanent residence — 82.6 % (р = 0.0001), or to those who moved preventively — 74.3 % (р = 0.0001). Adherence to therapy also depends on the status of the doctor. Among doctors with the status of an internally displaced person, patients’ adherence to therapy is lower: 68.3 against 82 % (р = 0.0008). Conclusions. Adherence to antihypertensive therapy in Ukraine during the war depends on known factors influencing the completeness of the doctor’s recommendations, including age, educational level, concomitant diseases, the number of tablets, and specific factors caused by the war, such as activity of hostilities in the region, as well as the status of an internally displaced person, both in patients and doctors.

Efficacy of combined antihypertensive therapy in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease with various polymorphisms of the CYP2C9 gene

Background. The difficulty of achieving target blood pressure (BP) levels in patients with arterial hypertension (AH) is often due to their type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). In turn, taking into account the individual genetic characteristics of the body helps to personalize treatment and make it more effective. Aim. To compare the antihypertensive efficacy of a fixed combination of amlodipine and olmesartan medoxomil (Aml/Ol-M) in patients with hypertension and T2DM, with and without NAFLD, depending on the polymorphism of the CYP2C9 gene. Materials and methods. The study included 139 patients with uncontrolled hypertension and concomitant T2DM; after diagnosis of NAFLD, they were randomized into 2 groups: without NAFLD (group 1, n=70), with NAFLD (group 2, n = 69). After discontinuation of previous ineffective antihypertensive therapy, they were prescribed a combination of Aml/Ol-M in doses of 5-10/20-40 mg/day. At baseline, 4, 8, 12 and 24 weeks, their office BP levels were determined; Also, at the initial visit and after 24 weeks of treatment, the main indicators of 24-hour blood pressure monitoring (ABPM) were measured. Patients who did not reach the blood pressure target within 12 weeks of therapy were excluded from the study. Those who continued to participate in the amplifierThe Rotor Gene-Q allele discrimination method revealed the following distribution of polymorphic variants of the CYP2C9 gene: *1/*1 was found in 52 and 47, *1/*2 – in 6 and 5, *1/*3 – in 5 and 6 subjects, for groups 1 and 2, respectively. Results. The initial levels of office BP values were significantly higher in patients of group 2 and amounted to 153,5 mm Hg for systolic and 93 mm Hg for diastolic blood pressure, compared with 145 mm Hg and 88 mm Hg those included in group 1. After 12 weeks of therapy, the achievement of target blood pressure was registered in 63 (90 %) patients of group 1 and in 58 (84,1 %) of group 2. After 24 weeks of observation, in both groups a beneficial effect of the studied combination of drugs on all indicators of ABPM was noted, but a more pronounced improvement was noted in patients with NAFLD. Along with this, significant improvements in daily blood pressure profiles were registered in both groups 1 and 2: an increase in the number of patients with the “dipper” profile and a decrease in the number of patients with the pathological “non-dipper” profile. The antihypertensive effectiveness of Aml/Ol-M has been demonstrated for all isolated allelic variants of the CYP2C9 gene. Conclusions. A 24-week study with the use of Aml/Ol-M demonstrated a high incidence of achieving office BP target values in patients with hypertension and T2DM, with and without NAFLD. However, a more pronounced decrease in ABPM levels was found in patients with NAFLD. Carriage of any of the identified polymorphic gene variantsCYP2C9 had no effect on the clinical effects of the studied combination.

Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)

Assessing blood pressure control and antihypertensive therapy in patients with hypertension: a comparison with one-year medical records data in Bulgaria (SNAPSHOT study)

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.