Antihypertensive Therapy In Patients Research Articles

Blood Pressure Variability Predicts Adverse Events and Cardiovascular Outcomes in Chronic Kidney Disease: A Post-Hoc Analysis of the SPRINT Trial.

Visit-to-visit blood pressure variability has been associated with adverse cardiovascular outcomes. Using the SPRINT trial data set, we explored the relationship between blood pressure variability, cardiovascular outcomes, and hypoperfusion-related adverse events of antihypertensive therapy in patients with chronic kidney disease (CKD) enrolled in the study. The analyses included patients with CKD randomized in SPRINT who reached the target systolic blood pressure for their respective groups (intensive <120 mm Hg; standard <140 mm Hg). Coefficients of variation (CV) for diastolic blood pressure (DBP) for each subject characterized variability. Cox proportional hazards regression was used to identify independent predictors of the SPRINT primary outcome (including acute coronary syndrome, stroke, acute heart failure, and death from cardiovascular causes) and the 3 major side effects of therapy-hypotension, syncope, and acute kidney injury (AKI). P <0.15 on univariate analysis was required to enter the model, and P <0.05 to remain in it. Overall, 2,488 subjects (1,273 standard; 1,124 intensive) met inclusion criteria. DBP CV predicted a greater hazard for primary outcome (hazard ratio [HR] 1.126, P < 0.0001) in the overall model as well as in separate analyses by treatment arms (standard group HR 1.107, P < 0.0001; intensive group HR 1.100, P = 0.0004). DBP CV also independently predicted a greater hazard for AKI (HR 1.117), syncope (HR 1.111), and hypotensive events (HR 1.104). Visit-to-visit DBP variability independently predicts worse cardiovascular outcomes and hypoperfusion-related adverse events in patients with CKD enrolled in SPRINT.

Сombined antihypertensive therapy in patients with diabetes mellitus and arterial hypertension

The article presents the data about incidence rate of arterial hypertension in patients with diabetes mellitus (DM) and risk for development of complications. DM is associated with an increased risk of hypertension. Arterial hypertension as comorbidity is present in 20–25% of patients suffering from DM. Simultaneous presence of these two diseases results in a significant increase of cardiovascular risk. Based on the modern recommendations there were discussed issues of target level for arterial blood pressure (BP) in patients with DM including diabetic kidney disease, the onset of medicated antihypertensive therapy and selection of antihypertensive drugs. Antihypertensive drugs can decrease cardiovascular morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain BP targets. Monotherapy can effectively reduce BP only in 20–40% of patients. Combined drug therapy is usually required to achieve the BP target value of &lt;130/80 mmHg defined for patients with diabetes. Сombined treatment for hypertension most often include a renin-angiotensin-aldosterone system (RAAS) inhibitor such as angiotensin converting enzyme-inhibitors or angiotensin receptor blockers. These can be/must be combined with low dose, primarily thiazide-like diuretics, calcium channel blockers with neutral metabolic effect, and further options include the addition of beta blockers or alpha-1-adrenoreceptor blockers.

Optimization combination antihypertensive therapy in patients with hypertension depending on indicators daily monitoring of blood pressure

Optimization combination antihypertensive therapy in patients with hypertension depending on indicators daily monitoring of blood pressure

Angiotensin receptor blocker telmisartan: efficacy, safety and relevance of clinical application

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.

ОЦІНКА ЕФЕКТИВНОСТІ ЛІКУВАННЯ АРТЕРІАЛЬНОЇ ГІПЕРТЕНЗІЇ ЗА ДАНИМИ ФАРМАКОЕПІДЕМІОЛОГІЧНОГО ТА ФАРМАКОЕКОНОМІЧНОГО АНАЛІЗУ

Метою даного дослідження було оцінити на основі ретроспективного фармакоепідеміологічного аналізу ефективність лікування артеріальної гіпертензії, дати фармакоекономічну оцінку антигіпертензивних лікарських засобів, розробити шляхи оптимізації антигіпертензивної терапії у хворих в лікарняних закладах охорони здоров’я.

Antihypertensive therapy in patients over 65 years of age

Antihypertensive therapy in patients over 65 years of age

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.

FEATURES OF MANAGEMENT OF PATIENTS WITH HYPERTENSION IN COMBINATION WITH ISCHEMIC HEART DISEASE: MODERN APPROACHES

The main positions of the American guidelines on management of patients with hypertension and concomitant ischemic heart disease (2015) are discussed in the article. Questions about the target blood pressure levels and the choice of the main classes of antihypertensive drugs, depending on the history of myocardial infarction, diabetes mellitus, and chronic kidney disease are presented. The principles of management of hypertensive patients with stable angina and acute coronary syndrome are discussed separately. The place of amlodipine in the therapy of patients with hypertension and ischemic heart disease is also being considered. Analysis of the large number of patients presented in the VALUE, CAMELOT and PREVENT studies allows one to more reliably talk about the pleiotropic effects of amlodipine and to determine its place in the antihypertensive therapy of patients with subclinical and symptomatic atherosclerosis. Possible potentiating effect of angiotensin converting enzyme inhibitors and amlodipine is also discussed in the article. This allows us to consider amlodipine as one of the key components of antihypertensive therapy in patients with ischemic heart disease, which contributes not only to accelerated normalization of blood pressure but also to a decrease in cardiovascular risk.

RENAL-ASSOCIATED ESCAPE EFFECT OF ANTIHYPERTENSIVE THERAPY IN HYPERTENSIVE PATIENTS RECEIVING NONSTEROIDAL ANTI-INFLAMMA‑ TORY DRUGS (“PANDA” TRIAL)

Objective. The subanalysis of the study “PANDA” (the study of renal function in patients with acute nonspecific pain in lower back during therapy with nonsteroidal anti-inflammatory drugs (NSAID)) is the study of renal-associated escape effect of antihypertensive therapy in patients with arterial hypertension (HTN) receiving NSAID. Design and methods. We included 407 patients receiving one of the following NSAIDs for 14 days: meloxicam (15 mg/day), etoricoxib (60 mg/day), nimesulide (200 mg/day) or celecoxib (200 mg/day). Five visits were performed. During the visits blood pressure (BP), glomerular filtration rate (GFR), blood levels of cystatin C were assessed. Results. At first step, all parameters were evaluated in the whole group (n = 407). As the second step, we analyzeds the indicators in 4 groups depending on the NSAID type. At the third stage (subanalysis) we allocated 3 groups of patients: 1 group (n = 62) — patients with a history of HTN and diabetes mellitus, group 2 (n = 173) patients with HTN, and group 3 (n = 172) — patients without HTN and diabetes mellitus. Conclusions . In patients with acute nonspecific back pain, with a history of HTN, NSAID intake is associated with the certain changes in BP, GFR and cystatin-С. Therefore, we can discuss a renal-associated escape effect of antihypertensive therapy. It is the most evident on the 7th day of NSAID therapy. All changes of the studied parameters should be considered as a class-effect adverse reactions of NSAIDs, without any benefits in relation to specific medications.

STUDY OF THE PARAMETERS OF TOLERABILITY AND ADHERENCE TO THERAPY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH FIXED COMBINATION OF RAMIPRIL AND AMLODIPINE (ACCORDING TO THE RESULTS OF OBSERVATIONAL STUDY "GRANAT-2")

Working group of the “GRANAT-2” study: Tula - Trubitsyn G.I., Ivanov Yu.V., Mirenkova O.K., Eskova R.A., Simonova R.P., Milon M.E., Telegina E.V., Kuznetsov A.M., Zhukova N.A., Zainullina I.K.; Rostov-on-Don - Budanov O.V., London E.M., Minosyan L.V., Nedashkovskaya N.G., Ter-Ananyants Ye.A.; Tomsk - Proskokova I.Yu., Permyakova O.V., Politova L.V., Maneeva I.D., Ivanova S.Yu.; Nizhny Novgorod - Larina O.V., Pokrovskaya I.N., Patselt E.A.; Moscow - Sladkova T.A., Zelenova Т.V. Aim. To study the tolerability and adherence to antihypertensive therapy in patients with hypertension and chronic obstructive pulmonary disease (COPD) using the fixed combination of ramipril and amlodipine in the observational program for patients with arterial hypertension and COPD (GRANAT-2). Material and methods. Patients with hypertension and COPD (n=52) with all inclusion criteria and without exclusion criteria who signed informed consent to participate in the GRANAT-2 program were included into the study. The use of a fixed combination of ramipril and amlodipine was recommended in all patients. The doses were determined by the treating physicians in accordance with the official drug instruction. The patients had 4 visits, and the duration of the study was 5 months. The Morisky-Green test was used to assess an adherence of patients to treatment. Assessments of blood pressure, adverse events were performed at all visits. Results. 50 of 52 patients completed the study: 45 patients used the studied fixed combination in the recommended doses, and 5 patients used other antihypertensive drugs, 2 patients withdrew from the study. Systolic blood pressure after 1 month of treatment decreased by an average of 20 mm Hg from the baseline, and diastolic blood pressure – by 10 mmHg. These rates after 5 months of therapy were 29 mm Hg and 15 mm Hg, respectively. Target blood pressure level was achieved in all patients. Increase in adherence of patients to treatment (according to the Morisky-Green test from 21.1% to 65.1%) was found. 2 cases of adverse events (dry cough) were registered. The discrepancy in adherence assessment was revealed between the results from the Morisky-Green test and the data from program case report forms. Conclusion. Regular patient visits to the doctor and the rapid achievement of an antihypertensive effect with good tolerability of a fixed combination of ramipril and amlodipine contributed to the increase in adherence of patients to treatment. Undesirable effects of the drug therapy are significant, but not leading factors that have a negative impact on the patient adherence to treatment.

The Effectiveness of Combination Antihypertensive Therapy in Women With Hypothyroidism and the Metabolic Syndrome

Evaluating the effectiveness of the various options of combination antihypertensive therapy (AHT) in women with arterial hypertension (AH) and metabolic syndrome (MS) and hypothyroidism. The study included 163 women with hypertension, metabolic syndrome, and hypothyroidism, the median age of 53.5 (48-60) years; in 73 (44.8%) women were diagnosed with subclinical hypothyroidism (SH), 90 (55.2%) - overt hypothyroidism (OH). Patients with both SH and OH, depending on the source of the heart rate (HR) was appointed as one of the following combination of AHT. If heart rate <75 beats/min, patients (n=100) received a combination of the dihydropyridine calcium antagonist (AA) amlodipine 5 mg/day, and angiotensin receptor blockers II (ARB) losartan 50 mg/day, with heart rate >75 beats/min (n=63) - a combination of amlodipine 5 mg/day and imidazoline receptor agonist (IRA) moxonidine 200 micrograms/day. The failure to achieve target blood pressure (BP) after 4 weeks of dose drugs doubled with subsequent evaluation of the effectiveness even after 4 weeks. At baseline and after 6 months of therapy, all patients underwent daily blood pressure monitoring (DBPM). At 8 weeks, the use of a combination of AA+ARB target BP level was registered in 26 (59%) of 44 women with SH and 34 (60.7%) of the 56 - OH. In the group of women who took the AA+IRA, after 8 weeks of the target blood pressure was observed in 24 (82.8%) of 29 patients with SH and 28 (82.4%) of 34 - to OH. Register the target blood pressure was observed significantly more frequently (p<0,05) when using a combination of AA+IRA compared with AA+ARBs as with SH and OH. As a result of the combination of DBPM AA and ARBs in patients with SH and OG provided a significant reduction in average daily, daytime and nighttime systolic and diastolic blood pressure (SBP and DBP), the time index of SBP and DBP during the day and night hours. The therapy of AA and IRA regardless of the severity of hypothyroidism, there was a significant improvement in all indicators DBPM: average daily, daytime and nighttime SBP and DBP, time index and variability in SBP and DBP during the day and at night. Furthermore, as in the SH and OH significantly more pronounced positive changes most DBPM parameters were recorded using IRA in combination with AA compared with a combination AA+ARB. Significant increase in the number of women with optimal BP daily profile "dipper" observed only when using amlodipine and moxonidine. In women with hypertension, hypothyroidism and MS, regardless of the severity of decline of thyroid function and combination of the dihydropyridine AA IRA had an advantage over the AA combination with ARBs, since most patients provided achieving target blood pressure and clinically significant positive impact on BPM indicators. The results can be used in selecting the optimal AHT in patients with hypertension, MS, and the manifest subclinical hypothyroidism.

Short-term esmolol attenuates remodeling of the thoracic aorta in hypertensive rats by decreasing concentrations of ADMA down-regulated by oxidative stress

Esmolol produces early regression of left ventricular hypertrophy and improves coronary artery remodeling, although the impact of short-term treatment with this beta-blocker on remodeling in large arteries has not yet been studied. We hypothesized that even a short (48h) course of esmolol might alter remodeling of the aorta in the spontaneously hypertensive rat (SHR). Fourteen-month-old male SHRs were treated intravenously with vehicle (SHR, n=8) or esmolol (SHR-E, n=8) (300μg/kg/min). Age-matched, vehicle-treated male Wistar-Kyoto rats (WKY, n=8) served as controls. After 48h, we studied the structure, volume density of elastic fibers, and passive mechanical properties of the aorta. Determination of asymmetrical dimethylarginine concentrations and total protein carbonyls in the aorta were analyzed. Esmolol significantly attenuated abnormal aortic wall thickness, cross-sectional area, wall-to-lumen ratio, volume density of elastic fibers, and wall stiffness. The protective effect of esmolol could be related to a decrease in asymmetrical dimethylarginine levels after down-regulation by oxidative stress. These findings could play a key role in the selection of antihypertensive therapy in patients with hypertension and aortic remodeling.

Patient adherence to antihypertensive therapy and its individual psychological factors

Background In the treatment of chronic, especially asymptomatic pathology one of the main problem is the adherence to therapy. Patients with arterial hypertension need long-term, often lifelong medication, and how strictly they adhere to prescriptions often determines the course of the disease and the medical measures effectiveness. According to statistics, more than half of patients with hypertension are characterized by low compliance, which leads to complications of this disease. The objective of the research is to identify and analize the individual psychological factors that determine patient adherence to antihypertensive therapy. Methods and materials This study was conducted during 2011-2013 at the cardiology departments of the Kyiv Alexander Hospital, polyclinics number 2 Shevchenko district in Kyiv, Desnyanskiy clinic №3 district in Kyiv, medical center "Adonis plus". We examined 203 patients with arterial hypertension (average age 53,5 ± 4,5 years). Methods: socio-demographic, clinical, clinical and psychological, psychodiagnostical, mathematical and statistical methods. Psychodiagnostical method included: 8-item Morisky medical adherence scale (Morisky D. E., 2008); self-assessment anxiety scale Charles D. Spielberger – Y.L Hanin (A.V. Batarshev, 2005); the Minnesota Multiphasic Personality Inventory questionnaire (MMRI) (F.B. Berezin, 1994); "The level of subjective control" (A.A. Rean, 2001); "Index of attitudes to health" (S.D. Deryabo, VA Yasvin, 2000). Results According to the results of 8-item Morisky medical adherence scale patients were divided into 3 groups according to the level of compliance - with high (26.11%), average (24.14%) and low (49.75%) levels of adherence to antihypertensive therapy. The individual-psychological predictors of poor adherence to antihypertensive therapy include the following personal characteristics of patients: a low level of intensity of attitude to health, internal type of subjective control, a low endurance to stress, strain of defense mechanisms, emotional instability and self-esteem, impulsivity, nonconformnism, tendency to independence, stability of attitudes, commitment to relying on their own experience, conflict behavior, rigidity, self-centeredness, introversion, the need for updating their own individuality, lack of deepening into serious problems. Designed psychocorrective program, aimed at transformation of lifestyle of patients and formation of a conscious aspiring to health, showed high efficacy. Conclusion Adherence to antihypertensive therapy in patients with arterial hypertension depends on such individual psychological factors as personality characteristics, type of subjective control, anxiety level and the level of intensity of attitudes to health, that should also be considered during treatment of hypertension to predict the level of compliance. It is reasonable to involve medical psychologists in counseling and correction of patients with hypertension in cardiology departments and clinics to diagnose personality compliance factors, intensity of attitude to health, identifying patients at risk of low adherence to antihypertensive therapy and, if necessary, adjust the level of compliance.

Long-Term Results of Antihypertensive Therapy in Patients With Diabetes

The article discusses the results of observational studies to evaluate the efficacy of antihypertensive drugs in patients with diabetes who participated in the randomized clinical trials. The role of such studies to clarify the tactics of application of antihypertensive drugs in patients with diabetes. The possible conditions that ensure a lasting effect of antihypertensive drugs, in particular the choice of drugs belonging to the class definition.

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics.

To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic). A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted. Hospital charts and neuroimaging were utilized to determine the final diagnosis (ischemic stroke, TIA, ICH, or stroke mimic). A total of 960 patients were transported by EMS to ED with suspected stroke. Stroke was diagnosed in 544 patients (56.7%) (38.2% ischemic stroke, 12.2% TIA, 5.3% ICH) and 416 (43.2%) were considered mimics. Age-adjusted mean prehospital systolic BP (SBP) was higher in acute stroke patients (155.6 mm Hg; 95% confidence interval [CI]: 153.4-157.9 mm Hg) compared to mimics (146.1 mm Hg; 95% CI: 142.5-148.6 mm Hg; p < 0.001). Age-adjusted mean prehospital SBP was higher in ICH (172.3 mm Hg; 95% CI: 165.1-179.7 mm Hg) than in either ischemic stroke or TIA (154.7 mm Hg; 95% CI: 152.3-157.0 mm Hg; p < 0.001). Median (interquartile range) SBP drop from initial prehospital SBP to ED SBP was 4 mm Hg (-6 to 17 mm Hg). Mean prehospital SBP was strongly correlated with ED SBP (r = 0.82, p < 0.001). Prehospital SBP is higher in acute stroke relative to stroke mimics and highest in ICH. Given the stability of BP between initial EMS and ED measurements, it may be reasonable to test the feasibility and safety of prehospital antihypertensive therapy in patients with suspected acute stroke.

State of a large vessels and microcirculation - a new target for antihypertensive therapy in patients with hypertension and type 2 diabetes

Aim . To evaluate the effect of 12 weeks of complex therapy with the fixed combination of enalapril and indapamide on indicators of vascular stiffness of large arteries and parameters of skin microcirculation (MC) in patients with arterial hypertension (HT) and diabetes mellitus (DM) type 2. Material and methods. 30 patients with HT stage II-III in combination with DM type 2 aged 40-70 years were included into the study. The fixed combination of enalapril and indapamide in addition to lipid-lowering and hypoglycemic therapy was prescribed to all patients. Elastic properties of large arteries were assessed by analyzing the pulse wave velocity (PWV) and the calculation of the index of aortic stiffness (IAS). Skin MC and level of glycated hemoglobin (HbA1c) were also determined. Results. After the 12-week treatment all patients reached the target values of blood pressure (BP). Office systolic and diastolic BP levels decreased by 18.8 and 13.1% (p<0.05 for both), respectively. The treatment did not have a negative effect on glucose metabolism – HbA1C concentration decreased by 2.7%. PWV in the vessels of elastic and muscular types decreased by 10.8 and 10.1% (p<0.05 for both), respectively, and IAS decreased by 27.4% (p<0.05). Significant growth in factor myogenic regulation of MC and reduction in bypass indicator by 21.8% were found. Conclusion. Combined therapy with the inclusion of a fixed combination of enalapril and indapamide for 12 weeks had a high antihypertensive efficacy and good tolerability in patients with HT and DM type 2. Treatment significantly reduced the vascular stiffness of large arteries and improved the MC indices in these patients.

Abstract TP193: Antihypertensive Therapy in Patients With Pre-morbid Hypertension Does not Modify Short-term Outcome in Acute Ischemic Stroke

Background: Hypertension is a recognized risk factor for ischemic stroke. Recent studies have suggested that patients with acute hypertension on admission for acute ischemic stroke (AIS) have worse outcomes compared to patients who present with blood pressure values within normal range. We sought to determine whether patients who are medicated for chronic hypertension prior to admission have better outcomes following ischemic stroke compared to unmedicated patients. Methods: Patients who presented to our center with AIS between 07/2008-07/2014 were included if pertinent past medical history and medication status were available at admission. Logistic regression was used to assess differences in baseline, in-hospital, and outcome variables in patients with medicated hypertension (HTN+/M+) and unmedicated hypertension (HTN+/M-) as compared to those with no hypertension (HTN-). The primary outcome measure was poor functional outcome (modified Rankin Scale &gt; 2) on discharge. Results: A total of 1,401 cases were analyzed; 305 patients (21.8%) in the HTN- group, 200 patients (14.3%) in the HTN+/M- group, and 896 patients (63.9%) in the HTN+/M+ group. After adjustment for age, NIHSS score at baseline, and tPA administration, patients in the HTN- group were significantly less likely to experience poor functional outcome than patients in the HTN+/M+ group (OR=0.63, 95% CI 0.45-0.88, p=0.0031). There was no significant difference in likelihood of poor functional outcome between HTN+/M- and HTN+/M+ patients (OR=0.87, 95% CI 0.64-1.19, p=0.2870). Conclusions: The absence of hypertension in the setting of AIS is associated with lower odds of poor functional outcome. However, patients who were medicated for hypertension compared to those who had untreated hypertension did not differ in functional outcome following ischemic stroke, suggesting that the presence of hypertension contributes to outcome and this exposure is not completely ameliorated by antihypertensive therapy.

Effects of azilsartan medoxomil compared with olmesartan and valsartan on ambulatory and clinic blood pressure in patients with type 2 diabetes and prediabetes.

Background:Angiotensin receptor blockers (ARBs) are preferred antihypertensive therapies in patients with type 2 diabetes mellitus (T2DM). Azilsartan medoxomil (AZL-M) is a potent ARB for the treatment of stages 1-2 hypertension. We compared the efficacy, safety, and metabolic effects of AZL-M to both valsartan (VAL) and olmesartan (OLM), separately in patients with impaired fasting glucose (prediabetes mellitus) and T2DM.Methods:A pooled analysis of 3821 patients from three separate randomized placebo-controlled trials comparing the effects of AZL-M (40 and 80 mg), OLM (40 mg), VAL (320 mg), and placebo on changes in ambulatory and clinic blood pressure (BP) among patients with hypertension and prediabetes mellitus or T2DM was performed. Two analysis pools were created to facilitate comparisons: Pool A included patients who received placebo, AZL-M or OLM and Pool B included those who received AZL-M or VAL. Within each pool, patients were stratified by glycemic subgroups (normoglycemic, prediabetes mellitus, or T2DM) based on hemoglobin A1c values. Changes from baseline in both 24-h and clinic SBP were the primary efficacy assessments.Results:Baseline 24-h mean SBPs were approximately 145 and 146 mmHg in the prediabetes mellitus and T2DM subgroups, respectively; corresponding clinic SBPs were approximately 158 and 159 mmHg. Baseline hemoglobin A1c values for each subgroup (both pools) were normoglycemic, 5.3%; prediabetes mellitus, 6.0%; and T2DM, 6.9%. Changes from baseline in 24-h or clinic SBP were significantly greater with AZL-M, 80 mg compared with either OLM 40 mg or VAL 320 mg in all subgroups in each pool. Safety and tolerability were similar among the active treatment and placebo subgroups.Conclusion:These analyses indicate that AZL-M, 80 mg/day lowers SBP by a greater magnitude than OLM or VAL at maximally approved doses in patients with prediabetes mellitus and T2DM. These findings have important clinical implications for this high-risk patient group.

CURRENT PROSPECTS FOR THE TREATMENT OF DIABETES COMPLICATIONS

Arterial hypertension (AH) complicates the course of diabetes mellitus (DM) of both the 1st and 2nd type. In patients with diabetes type 1, the main cause of AH is diabetic nephropathy. In diabetes type 2, on the other hand, essential hypertension is diagnosed in 70-80% of cases. The choice of antihypertensive therapy in patients with diabetes is not easy; when selecting the best anti-hypertensive drug for a diabetes patient, the associated vascular complications should always be considered. Angiotensin-convertingenzyme inhibitors are the most common treatment of hypertension in diabetic patients. Damage of the nervous system - diabetic polyneuropathy (DPN) – is a key element in the clinical picture of diabetes. In the treatment of DPN, activation of neural regeneration (reinnervation) and pain management are crucial. Neurotropic B vitamins with multimodal effect play a key role in this.

Antihypertensive therapy in patients with coexisting hypertension and bronchial asthma

The aim of the research was to study the peculiarities of cardiac and pulmonary hemodynamics, the mechanisms of formation of endothelial dysfunction, as well as their correction with angiotensin converting enzyme inhibitor, Ramipril and angiotensin-II receptor blocker, Irbesartan, in patients with arterial hypertension (HTN) combined with bronchial asthma (BA). Design and methods . Altogether 80 patients with BA of moderate severity combined with HTN of 1, 2 degrees were enrolled in the study. The average age of the patients was 52,9 ± 4,2 years. The eligible patients were randomized for treatment with either Ramipril 5 mg/day or Irbesartan 150 mg/day in combination with bronchodilator inhalation and anti-inflammatory medications for BA (Formoterol/Budesonide 160/4,5 mcg 2 inhalations twice, Ipratropium bromide and Ambroxol through nebulizer devices). The program of instrumental examination included echocardiography (Aloka 1700, Japan; LOGIQ 500, Germany) with ultrasonic sensors of 3,5 MHz. The plasma level of endothelin 1 (ET‑1) was estimated by immune-enzyme assay (Biomedica set, category № 442–0052, Arkray, Japan). Results. Two-month monotherapy with Irbesartan allows to achieve the target blood pressure (BP), leads to the regression of cardiac remodeling and has a positive effect on endothelial function and bronchial patency. Conclusions. Irbesartan is able to provide a stable and reliable control of BP, and delays the progression of pathological cardiovascular changes; it has a favorable impact on the respiratory function, is well tolerated, easy to use, and may be considered as the best antihypertensive drug in patients with co-morbid HTN and BA.