Combined Antihypertensive Treatment Research Articles

Final conclusions of the own investigations of combined antihypertensive treatment on clinical state in patients with arterial hypertension without and with diabetes mellitus: use of own materials in education in nation. and Engl. languages at pre- and po

General practice – family medicine department. Object of investigation – patients with confirmed diagnosis of arterial hypertension without and with diabetes mellitus of second type, which were under observation at the primary medical care centers. 
 The aim of the investigation was the study of efficiency of the combined (calcium channel blocker – amlodipin besilat and angiotensin II receptor antagonist – valsartan) antihypertensive treatment in patients with arterial hypertension combined with diabetes mellitus from the start of the treatment in the practice of primary care physician.
 Methods of the investigation included physical examination, general clinical, instrumental and laboratory methods, monitoring of side effects.
 As a result it was found, that combined antihypertensive treatment (amlodipin and valsartan) is effective and safe in patients with arterial hypertension and diabetes mellitus of 2 type, which helps to reach the target level of arterial pressure in 72 % of patients and can be recommended from the beginning of the treatment in the practice of family physician. Maximal effect of the treatment in patients with arterial hypertension of II-III degree and diabetes mellitus of 2 type was observed only at 12th week of treatment. At combined antihypertensive treatment (amlodipin and valsartan) they observed tendency to the reduction of left ventricle hypertrophy. Despite the rate and percentage of the reaching of target arterial pressure were lower in the group of patients, which have diabetes mellitus of 2 type, it is necessary to recommend more active modification of the way of life in the named group of patients. It was found reduction of heart and vascular risks in the group of patients with arterial hypertension II–III degree with diabetes mellitus 2 type. This makes the basis for more active modification of life style and using from the start of the treatment combined antihypertensive therapy immediately. Consider all found results using from the start of the treatment combined antihypertensive therapy immediately by the primary care physician is proved for patients with arterial hypertension combined with diabetes mellitus.
 Accumulated materials (including theoretical reviews, demonstrative poster reports etc.) are used at training of interns in speciality «general practice – family medicine», during practical classes for higher courses education in national and English languages

Neuroprotective efficacy of combined antihypertensive treatment with the inclusion of nitrendipine in patients with arterial hypertension

Abstract Aim To evaluate the efficacy of 12-months combined antihypertensive treatment with the inclusion of nitrendipine on cognitive functions in patients with arterial hypertension (AH). Material and methods Surveyed 59 patients with I – III AH degree (ESH / ESC, 2018) of both sexes. The average age of patients was 58,8 ± 11.6 years, the average duration of AH 11.1 ± 7.04 years. An average daily dose 13.18±7.4 mg of nitrendipine was prescribed to patients with AH in combination with other antihypertensive drugs. Furthermore, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in all patients before and after 12 months treatment. Cognitive functions were evaluated using neuro-psychological tests: the Mini-Cog test (drawing a clock, reproduction of words), Montreal Cognitive Assessment (MoCA), a self-assessment questionnaire of memory, attention, thinking, ability to cope with their affairs, ability to make decisions. The results are presented as M ± SD. Results Analysis of office BP indicators showed a good 12-month antihypertensive efficacy with the inclusion of Nitrendipine in patients with AH. In particular, the SBP before treatment was 157,8 ± 16,18 mm Hg, after – 125,5 ± 10,7 (p = 0,000); the DBP 96,35 ± 8,55 mm Hg versus 79,7 ± 5,9 mm Hg, respectively (p = 0,000); MBP (mean blood pressure) 116,8 ± 9,95 mm Hg versus 94,97 ± 7,09 mm Hg, respectively (p = 0,000). The analysis of influence of AHT with the inclusion of Nitrendipine on cognitive functions in patients with AH showed an increase in the total score on the Mini-Cog test: 3,83 ± 1,11 versus 4,49 ± 0,81 points (p = 0,000), mainly due to a significant improvement in the reproduction of words: 2,16 ± 0,87 versus 2,69 ± 0,62 points (p = 0,000). According to the MOCA scale, abstract thinking significantly improved: initially amounting to 1,37±0,66 points versus 1,81±0,5 points in dynamics (p=0,000), as well as delayed reproduction of words: 2,49±1,23 points initially versus 3,2±1,4 points in dynamics (p=0,004). Significant memory improvement was observed against the background of 12-month antihypertensive therapy based on nitrendipine, initially was 7,04±2.34 points against 8,22±1.24 in dynamics (p=0,000) and decision-making function was 7,8±2,2 points initially against 9,02±1,3 in dynamics (p=0,000). Conclusion Thus, high antihypertensive efficacy and improvement of cognitive functions were shown against the background of antihypertensive combination therapy with the inclusion of nitrendipine in patients with AH.

Activity of Lysosomal Enzymes During Triple Combination Antihypertensive Treatment of Arterial Hypertension

Activity of Lysosomal Enzymes During Triple Combination Antihypertensive Treatment of Arterial Hypertension

The correlation between different antihypertensive treatments and prognosis of cardiovascular disease in hypertensive patients

ObjectiveTo determine the association between different antihypertensive regimens and cardiovascular disease (CVD) outcomes in hypertensive patients.MethodThis single center retrospective cohort study analyzed 602 hypertensive patients with complete medical records at Zhongnan Hospital of Wuhan University, China, from January 2016 to November 2022. Baseline data and follow-up data of the included patients were collected, including demographic and clinical characteristics and laboratory results.ResultsDuring the 5-year follow-up period, CVD outcomes occurred in 244 hypertensive patients (40.53%). Compared with patients receiving regular antihypertensive treatment, the incidence of adverse cardiovascular events in patients receiving irregular antihypertensive treatment was significantly higher (62 [55.86%] vs 182 [37.07%], HR 1.642, 95% CI 1.227–2.197, p < 0.001). In subgroup analysis, the results showed that the incidence of CVD was not identical (χ2 = 9.170, p = 0.010). The incidence of adverse cardiovascular events was highest in the single-drug antihypertensive treatment group (43.60%), followed by the multi-drug combination group (41.51%), and lowest in the two-drug combination group (29.58%). Kaplan–Meier curve showed that hypertensive patients treated with two-drug combination antihypertensive had longer overall survival time. We further compared the incidence of CVD between standard blood pressure and intensive blood pressure control, and found no significant difference in the incidence of adverse cardiovascular events between treatment to a systolic blood pressure (SBP) target of less than 140 mmHg compared with a SBP target of less than 120 mmHg (105 [43.93%] vs 35 [29.66%], HR 1.334, 95% CI 0.908–1.961, p = 0.142).ConclusionThe incidence of adverse cardiovascular events was significantly different among different antihypertension treatments. Kaplan–Meier survival curve showed that hypertensive patients receiving two-drug combination antihypertensive treatment had longer overall survival time.

“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.

Fixed combination antihypertensive treatment in hypertensive patients with obesity and dyslipidemia affects the heart and vascular remodeling

Background and Aims: Modern antihypertensive therapy is a rational combination of drugs that allows not only to achieve the target level of blood pressure, but also to reduce the risk of cardiovascular complications in patients with comorbid pathology. To study the effect of fixed combinations (FC) of antihypertensive therapy on the 24-hour BP profile, LV myocardial remodeling in hypertensive patients with obesity (O) and dyslipidemia (D).

THERAPEUTIC EFFECTS OF MINERAL CORTICOID RECEPTOR BLOCKER IN THE COMBINATION ANTIHYPERTENSIVE DRUG THERAPY IN HYPERTENSIVE PATIENTS

Objective: Among the components of renin-angiotensin-aldosterone system, aldosterone is supposed to facilitate the progression of cardiovascular organ injuries not only by promoting renal tubular Na reabsorption but also by causing oxidative stress, inflammation and cardiovascular tissue hypertrophy and fibrosis. Therefore, mineral corticoid receptor blockers (MRB) are expected to exhibit protective effects against cardiovascular organ injuries in hypertensive patients. In the present study, the therapeutic effects of MRB in the combination antihypertensive treatment were examined in hypertensive patients. Design and method: Fifty mg eplerenone (EPL) was added to 24 hypertensive patients under antihypertensive drug therapy who were not achieved the target blood pressure levels. The combination was continued for 3 to 4 months and the effects on blood pressure (BP) and laboratory data including renal function and cardiovascular endocrine system were evaluated. Results: After 3–4 months, office BP was lowered from 148/91 to 135/86 mmHg (p &lt; 0.001/p = 0.002) as well as the home BP (morning 150/86 to 134/81, p = 0.001/p = 0.033; evening 139/80 to 127/74, p = 0.005/p = 0.030). Serum K (4.2 to 4.3mEq/L, p = 0.014) and creatinine (0.82 to 0.87 mg/dL, P &lt; 0.001) were slightly but significantly increased. Serum uric acid was significantly also increased from 5.8 to 6.4 mg/dL (p = 0.015). However, the indices of glucose metabolism and serum lipids were not affected. In addition to the natural increases in plasma renin and aldosterone, plasma B-type natriuretic peptide (BNP: 23 to 17 pg/mL, p = 0.028) and urinary albumin excretion (111 to 70 mg/gCr, p = 0.009) were significantly decreased. Conclusions: In the combination antihypertensive drug therapy, MRB is expected to cardiac and renal injuries and the influences on glucose and lipid metabolisms seem negligible, however, care should be taken for the development of hyperuricemia and renal dysfunction in addition to hyperkalemia.

Arterial hypertension after heart transplantation

Aim To evaluate incidence of arterial hypertension (AH) in the posttransplantation period and to identify risk factors for this complication.Materials and methods From January, 2010 through December, 2017, 96 heart transplantations (HT) (70 men and 26 women aged 46.5±13.9 years) were performed. During the first month following HT, 8 recipients died and were excluded from the analysis. The retrospective evaluation of results included 88 patients followed up for more than one year.Results For the entire post-HT period (maximum 92 months), AH was observed in 75 of 88 (85%) recipients. Post-HT AH was correlated with male gender (r=0.24; p=0.031), history of smoking before HT (r=0.45; p&lt;0.001), history of ischemic heart disease (IHD) (r=0.28; p=0.01), older age (r=0.35; p=0.001), higher body weight index (r=0.37; p=0.0005), creatinine level (r=0.37; p=0.001), and low-density lipoprotein cholesterol level (r=0.27; p=0.04). Interrelations with other AH risk factors were not found. Most patients developed AH within the first two years after HT. During the first year, AH was diagnosed in 60% (53 of 88) of patients (relapse, 85% (n=29); newly diagnosed, 45% (n=24), p=0.0003). At two years, AH was detected in 79% (46 of 58) of patients (relapse, 53% (n=18); newly diagnosed, 53% (n=28), p=0.9). All recipients received an adequate antihypertensive therapy. 40-63% of patients required a single-drug therapy at different points of follow-up; from 29 to 45% of patients required a two-drug therapy, and 5-15% of patients required three or more drugs. During all 5 years of treatment, most patients used angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (70-87%) and slow calcium channel blockers (SCCB) (48-53%). The presence of AH following HT was associated with development of all cardiovascular events (CVE; r=0.31; p=0.012) whereas persistent AH, which required a combination antihypertensive treatment, was associated with a high mortality (r=0.61; p=0.015).Conclusion AH is a frequent complication of HT (85%), which is newly diagnosed in most patients during the first two years. AH incidence was higher for male recipients with a history of IHD, hypertension, and smoking. Approximately half of patients required only a single-drug antihypertensive therapy. After HT, the most frequently prescribed drugs included ACE inhibitors or ARBs and SCCBs (70-87% and 48-53%, respectively, depending on the time elapsed after HT). Persistent AH requiring a treatment with two or more antihypertensive drugs was associated with development of all CVEs and a higher long-term mortality.

Effects of combined exercise training and pharmacological treatment on blood pressure and renal parameters in an experimental model of hypertension and menopause.

In postmenopausal women, increased blood pressure (BP) has been well documented. Moreover, autonomic dysfunction, inflammation, and oxidative stress have important roles in the pathophysiology of hypertension, which was associated with end organ damage, such as the kidneys. On the other hand, pharmacological therapy and combined physical training have been clinically recommended for BP control. However, the impact of these therapies has not yet been fully understood, especially regarding to the impact on renal tissue. Thus, the aim of present study was to investigate the effects of combined physical training and antihypertensive pharmacological treatment on BP and renal parameters in an experimental model of hypertension and menopause. Spontaneously hypertensive 3‐month‐old rats (SHR) were divided into 5 groups: sedentary (S; n = 4), sedentary ovariectomized (SO; n = 4), hydrochlorothiazide‐treated sedentary ovariectomized (HSO; n = 4), trained ovariectomized (TO; n = 3) and trained hydrochlorothiazide‐treated ovariectomized (THO; n = 4). Ovariectomy was performed by bilateral removal of the ovaries. After 5 days of treatment (placebo or pharmacological) and adaptation to the treadmill and training ladder, groups S and OS continued with placebo treatment for 8 weeks, while the other groups continued treatment with antihypertensive drug (30mg / kg Hydrochlorothiazide diluted in drinking water) and / or CPT (3 days / week, 40–60% of maximum capacity). Tail plethysmography BP measurements were performed at one pre‐intervention week and at the 1st, 4th and 8th intervention weeks. At week 7, the rats were kept in metabolic cages for 24 hours to collect urine. There was no difference between the groups for pre‐intervention BP. The THO, TO and HSO groups had reduced BP levels compared to the SO group at the end of the protocol (p &lt;0.01). There was a correlation between physical capacity on stairs (PCS) and BP levels at week 1 (r = −0.49) and week 4 (r = −0.48). There is no difference in urinary output between groups; However, metabolic cage urine output correlated with treadmill physical capacity (PCT) (r = −0.47). Right kidney weight was significantly lower (p &lt;0,01) in TO and THO groups compared to SO group (0.63±0.01; 0.63±0.01 vs. 0.79±0.08 g). Kidney weight was correlated with PCT (r = −0.59), urinary output (r = 0.73) and water consumption (r = 0.53). In conclusion, despite the results suggest similar benefits of pharmacological and non‐pharmacological treatment in the management of BP in the presence of ovarian hormone deprivation, attenuation of hypertension and menopause induced‐renal alterations was associated with improvement in physical capacity.

THE EFFECTIVENESS OF COMBINATED ANTIHYPERTENSIVE TREATMENT IN PATIENTS WITH ESSENTIAL HYPERTENSION OF THE II-ND STAGE DEPENDING ON THE TYPE OF DAILY BLOOD PRESSURE PROFILE AND THE TYPE OF REMODELLING OF THE LEFT VENTRICLE

The aim: To evaluate the dynamics of structural and functional parameters of the heart, vessels in patients with hypertension of the II-nd stage under the influence of combined antihypertensive treatment depending on the type of the left ventricle remodelling and the profile of blood pressure (BP). Materials and methods: The study involved 110 patients with hypertension of the II-nd stage. The ambulatory blood pressure monitoring, echocardiography and Doppler examination of the shoulder arteries were performed. Initial treatment included bisoprolol, lisinopril, hydrochlorothiazide. With impossibility of BP lowering to the target level, amlodipine has been added. Results: higher levels of BP in the "non-dipper" patients have led to the development of more pronounced changes in the heart and vessels compared with "dipper" patients. Three-component therapy was effective in patients with lower BP. The prescription of amlodipine has been found to be necessary for the majority of "non-dipper" patients and for the minority of "dipper". Combined therapy effectively controlled the BP at the level of the target and contributed to a decrease in the displays of remodelling of the heart and blood vessels. Conclusions: combined therapy used for 6 months reduces displays of disadaptive heart and vascular remodelling, diastolic, endothelial dysfunction. With the lack of efficacy of the therapy, which includes bisoprolol, lisinopril, hydrochlorothiazide, the adding of amlodipine to it can reach the target level of BP.

Blood pressure control in chronic kidney disease according to underlying renal disease: the Fukushima CKD cohort.

Inadequate blood pressure control is one of the important causes of chronic kidney disease (CKD), but only a limited number of reports have examined blood pressure control in Japanese patients with pre-dialysis CKD. Differences in blood pressure control due to underlying renal disease in pre-dialysis patients with CKD were investigated in the present study using the baseline data of the Fukushima CKD cohort study. The study involved 1351 CKD patients, classified by underlying disease of primary renal disease, hypertensive nephropathy, diabetic nephropathy, other nephropathies, or unknown. Target blood pressure of CKD patients was defined as < 130/80mmHg in patients under 75years old with diabetes and/or proteinuria, and < 140/90mmHg in other patients. The achievement rate of target systolic blood pressure was lower in the diabetic and hypertensive nephropathy groups than in the primary renal disease group (33.3%, 46.0% vs. 68.1%, p < 0.001). However, the number of antihypertensive medications increased in the diabetic and hypertensive nephropathy groups compared to the primary renal disease group (2.16, 2.04 vs. 1.55, p < 0.001). Inadequate blood pressure control was independently related to the underlying renal disease, with a significant difference between diabetic nephropathy and primary renal disease (odds ratio 3.19; 95% confidence interval, 2.16-4.69; p < 0.001). This study showed that blood pressure control differs by the underlying renal disease. Blood pressure control was poor especially in diabetic nephropathy despite multidrug combination antihypertensive treatment. It is necessary to verify whether strict blood pressure control improves patients' prognosis in diabetic nephropathy.

Münchausen Syndrome as an Unusual Cause of Pseudo-resistant Hypertension: A Case Report.

Münchausen syndrome can be characterized by simulated illness, pathological lying and wandering from place to place (the patient typically presents to numerous hospitals). Individuals with elevated blood pressure due to non-adherence to medication have the so-called pseudo-resistant hypertension.A 45-year-old woman was admitted to hospital on an emergency basis because of a hypertensive crisis. Despite combination antihypertensive treatment, normalization of blood pressure was not achieved and a device to produce a therapeutic arteriovenous fi stula was implanted. Aft er the procedure, a signifi cant increase in pulmonary artery pressure was observed and closure of the fistula was performed by implantation of the stent graft . The suspicion was raised that the patient had not been taking her prescribed medications. Therefore, blood samples were taken and the serum was analyzed for presence of the prescribed drugs (atorvastatin, bisoprolol, chlorthalidone, clonidine, doxazosin, furosemide, nitrendipine, oxazepam and valsartan). The results confirmed suspected failure of the patient to take the prescribed medications.Münchausen syndrome is usually first suspected when inexplicable laboratory test results are noted. To our knowledge, this is the first reported case of Münchausen syndrome with pseudo-resistant hypertension leading to the implantation of a device to produce a therapeutic arteriovenous fi stula.

Influence of combined antihypertensive and hypolipidemic therapy on blood pressure and parameters of arterial wall stiffness in patients with hypertension

Arterial hypertension and atherosclerosis are some of the most global problems in modern medicine. In the last decade more attention is paid to the state of central hemodynamics and arterial stiffness in patients with cardiovascular diseases, including hypertension, as one of the markers of hypertension-mediated organ damage and as a predictor of CV events. The main method of correction and tight control of blood pressure and dyslipidemia is combined antihypertensive and statin therapy. 30 patients with arterial hypertension at stage 2 and high-cardiovascular risk were involved at this study. It was detected that long-term treatment with a fixed combination of lisinopril and amlodipine in combination with rosuvastatin leads not only to normalization of blood pressure, but also to a significant decreasing of central blood pressure and a reduction in pulse wave velocity. This can act as a criterion for the organoprotective action of the combined antihypertensive and lipid lowering treatment.

Dynamics of testosterone and prolactin levels, blood pressure and parameters of cardiovascular remodeling in hypertensive men with androgen deficiency in the course of treatment

Numerous previous and up-to-date guidelines for antihypertensive treatment do not highlight the problem of interrelations between sexual dysfunction and hypertension itself or with the use of frequently prescribed medications. Changes in testosterone and prolactin concentrations in men undergoing antihypertensive treatment are still not well described.The aim of the study was to investigate the impact of combined antihypertensive treatment with the addition of phenibut on testosterone and prolactin concentrations, blood pressure and parameters of cardiovascular remodeling in hypertensive men with androgen deficiency.Materials and methods. A total of 113 men with stage II essential hypertension were recruited to participate in the study. All patients were subjected to routine clinical examination, evaluation of total (TT), free testosterone (FT) and prolactin using ELISA, 24-hour blood pressure monitoring (24-hour BPM), assessment of central aortic pressure and arterial stiffness, transthoracic echocardiography. All study subjects were prescribed the combined antihypertensive treatment with irbesartan and nifedipine. Depending on treatment scheme, all patients were divided into four groups: group 1A consisted of men with low TT who received phenibut in addition to antihypertensive treatment, group 1B – patients with androgen deficiency on antihypertensive treatment only, group 2A – patients with normal TT with the addition of phenibut, group 2B – men with normal TT on antihypertensive medications only.Results. As a result of prescribed treatment, TT and FT levels increased with discordant changes in the concentration of prolactin: a statistically significant increase in TT (29.72 %, P = 0.0002) and FT (28.08 %, P = 0.0003) with a significant decrease in prolactin concentrations (10.68 %, P = 0.008) were in the group 1A. All patients had positive 24-hour BPM dynamics, parameters of central aortic pressure and cardiovascular remodeling. Patients with androgen deficiency with the addition of phenibut had the highest reduction rates in 24-hour BPM values, central SBP, DBP, PBP, mean BP, augmentation index, RWTT, pulse pressure amplification, CAVIa and were characterized by significant improvement of longitudinal LV deformation and diastolic function.Conclusions. The use of combined antihypertensive therapy with irbesartan and nifedipine with the addition of phenibut in men with androgen deficiency contributes to the achievement of target blood pressure levels and improvement of cardiovascular remodeling parameters.

Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?

Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55±9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mm Hg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9±11.8 versus -0.3±10.3 mm Hg; 18 months, -6.7±11.1 versus -1.2±10.6 mm Hg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3±1.9 versus 9.2±1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.

Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study.

BackgroundThe majority of people with hypertension require more than one medication to achieve blood pressure control. Many patients are prescribed multipill antihypertensive regimens rather than single-pill fixed-dose combination (FDC) treatment. Although FDC use may improve medication adherence, the impact on patient outcomes is unclear. We compared clinical outcomes and medication adherence with FDC therapy versus multipill combination therapy in a real-world setting using linked clinical and administrative databases.Methods and findingsWe conducted a population-based retrospective cohort study of 13,350 individuals 66 years and older in Ontario, Canada with up to 5 years of follow-up. We included individuals who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II-receptor blocker (ARB) plus one thiazide diuretic. High-dimensional propensity score matching was used to compare individuals receiving FDC versus multipill therapy. The primary outcome was a composite of death or hospitalization for acute myocardial infarction (AMI), heart failure, or stroke. We conducted 2 analyses to examine the association between adherence and patient outcomes. First, we performed an on-treatment analysis to determine whether outcomes differed between groups while patients were on treatment, censoring patients when they first discontinued treatment, defined as not receiving medications within 150% of the previous days’ supply. Second, we conducted an intention-to-treat analysis that followed individuals allowing for breaks in treatment to quantify the difference in drug adherence between groups and assess its impact on clinical outcomes. As expected, there was no significant difference in the primary outcome between groups in the on-treatment analysis (HR 1.06, 95% CI 0.86–1.31, P = 0.60). In the intention-to-treat analysis, the proportion of total follow-up days covered with medications was significantly greater in the FDC group (70%; IQR 19–98) than in the multipill group (42%, IQR 11–91, P < 0.01), and the primary outcome was less frequent in FDC recipients (3.4 versus 3.9 events per 100 person-years; HR 0.89, 95% CI 0.81–0.97, P < 0.01). The main limitations of this study were the lack of data regarding cause of death and blood pressure measurements and the possibility of residual confounding.ConclusionsAmong older adults initiating combination antihypertensive treatment, FDC therapy was associated with a significantly lower risk of composite clinical outcomes, which may be related to better medication adherence.

THE ROLE OF HIGH DIETARY SALT INTAKE IN DEVELOPMENT OF RESISTANT HYPERTENSION

Objective: Aim of the study: evaluate salt-taste sensitivity and daily salt intake in patients with resistant arterial hypertension (RAH) during antihypertensive treatment (AHT). Design and method: The study included 137 patients with high risk arterial hypertension in average age 56.6 ± 9.8 years. All patients took triple combination AHT with diuretic, RAAS-blocker and calcium antagonists during 3 months. After 3 months therapy 83.2% patients were achieved goal BP, 16.8% of them were resistant to triple combination AHT. Thus, patients divided into 2 groups: RAH (n = 23) and non-RAH (n = 114) and continued AHT with recommendation to reduce dietary salt intake to 5–6 g/24 h. Salt-taste sensitivity (STS) evaluation, implemented R.Henkin method with using sodium chloride in different concentration: from 0.01% to 1.28%. The patients divided to 3 STS thresholds: low (0.01%-0.08% NaCl), medium (0.16% NaCl), and high thresholds (>0.32% NaCl). Daily salt intake was calculated by urinary sodium excretion level multiply 2.55, before and after treatment. Results: Patients with RAH characterized with significantly high systolic and diastolic BP (SBP/DBP): 178.1 ± 15.4/103.3 ± 10.1 mmHg vs. 158.9 ± 13.3/98.7 ± 7.25 mmHg in non-RAH group (p = 0.0001). STS test was shown prevalence high threshold of STS in RAH patients (high/medium 90.5%/9.5% χ2 = 46.7, p = 0.0001) in comparison with non-RAH group (high/medium/low 74%/12%/14% χ2 = 130.4, p = 0.0001) with significant difference in sodium chloride concentration: 0.41 ± 0.17% vs. 0.3 ± 0.18%, p = 0.01, for RAH and non-RAH groups respectively. Before AHT daily urinary sodium excretion rate was high in RAH patients (5.66 ± 2.49 g/24 h vs. 4.5 ± 2.54 g/24 h, p = 0.056), that corresponded to 14.4 g and 11.47 g daily salt intake in RAH and non-RAH respectively. During 6 months therapy BP significantly decreased in both groups, but in non-RAH group BP reducing was better with statistical difference: 128.3 ± 11.46/80.8 ± 7.9 mmHg vs. 122.4 ± 6.0/76.36 ± 8.5 mmHg, p = 0.0001 and p = 0.022 for SBP and DBP respectively. Daily urinary sodium excretion rate was significantly decreased only in non-RAH patients in comparison with RAH patients with statistical difference: 3.8 ± 2.29 g/24 h vs. 5.46 ± 2.7 g/24 h (p = 0.006). Conclusions: Patients with RAH characterized with high STS threshold and dietary salt intake. During six monthly optimal AHT, BP significantly reducing in both groups, but in non-RAH patients BP and daily urinary sodium excretion was statistically lower.

PP.08.03] SLEEP BREATHING DISORDERS AS A KEY DETERMINANT FOR DEVELOPMENT OF UNCONTROLLED ARTERIAL HYPERTENSION

Objective: The purpose of this study is to investigate the role of sleep disordered breathing, particularly obstructive sleep apnea-hypopnea syndrome (OSAS) in inadequate control of blood pressure in patients with arterial hypertension (AH). Design and method: 72 patients with AH (mean age 48.0 ± 11.2y) and regular antihypertensive treatment, as a monotherapy or combined treatment have been included in the given study. All patients have had apnea-hypopnea index (AHI) values > = 5.0 episode/hour according to the polysomnographic investigation. Men (n = 64) and patients with severe OSAS (AHI > = 30.0 episode/hour) have prevailed in the study population (88.9% and 79.2%, respectively). Results: 48 (66.7%) patients with OSAS and antihypertensive treatment have had uncontrolled and different severity degrees of AH in the moment of investigation. Meanwhile the I, II and III degrees of AH have been stated in 29.2%, 22.2% and 15.3% of cases respectively. It is noteworthy that antihypertensive treatment parameters characterizing drug quantity and doses, their pharmacological groups and combinations have been equivalent for both groups of patients with controlled and uncontrolled AH, therefore couldn’t motivate the fact for insufficient control of AH. In this view uncontrolled AH has been revealed in 73.7% of patients with severe OSAS (AHI) > = 30.0 episode/hour), while the same ratio has been only 40.0% for groups of patients with mild or moderate OSAS. It should be noted that OSAS conditioned micro- and macro-arousals induced by the apnea-hypopnea episodes, sleep fragmentation and changes of its structure, including impaired relations between «slow-wave» and «rapid-wave» different stages lead to the significant changes of sympathetic-parasympathetic equilibrium, which, by itself, can suppose additional difficulties in AH drug control. Conclusions: The two-third of patients with OSAS, despite of the presence of combined antihypertensive treatment, has had high blood pressure levels. Thus severity of OSAS can be considered as a key predictor for manifestation of uncontrolled AH.

ОПТИМІЗАЦІЯ ЛІКУВАННЯ ДІАСТОЛІЧНОЇ СЕРЦЕВОЇ НЕДОСТАТНОСТІ У ПАЦІЄНТІВ ІЗ ГІПЕРТОНІЧНОЮ ХВОРОБОЮ В УМОВАХ КОМОРБІДНОСТІ З ГІПЕРУРИКЕМІЄЮ

У пацієнтів із гіпертонічноюхворобою (ГХ) з нормо- та гіперурикемією ми провели дослідження впливу комбінованої антигіпертензивної терапії з включенням ІаПФ лізиноприлу або ара ІІ вальсартану на діастолічну дисфункцію лівого шлуночка (ДДлш). було обстежено 137 пацієнтів із Гх ІІ стадії з 2–3 ступенями АГ: 74 хворих були з безсимптомною гіперурикемією (ГУЕ) (основна група) та 63 – з нормальними показниками рівня сечової кислоти (СК) (група порівняння). було встановлено пряму кореляцію між показником ДДЛШЕ/Е’ та рівнем сечової кислоти (СК), що свідчить про те, що у пацієнтів із аГ коморбідність із ГУе частішепоєднується із порушенням діастолічної функції лш. При цьому рівень сК при псевдонормальному типі ДДЛШ був вищим, ніж при релаксаційному типі у групі контролю здорових осіб. Через 6 місяців у групі вальсартану було виявлено більш значне поліпшення ДДЛШ як в групі з нормо-, так і згіперурикемією. Порівнюючи динаміку СК після проведеного лікування, було виявлено, що вона достовірно знижувалась у групі пацієнтів, які приймали вальсартан, порівняно з групою лізиноприлу, в якій не було виявлено достовірної різниці рівня СК у динаміці лікування.

Management of hypertension and multiple risk factors to enhance cardiovascular health - a feasibility study in Singapore polyclinics.

BackgroundHigh blood pressure (BP) is a leading contributor to cardiovascular mortality globally. There is scarcity of information on effective health systems interventions to lower BP and reduce cardiovascular risk in Southeast Asian countries. We conducted a pilot exploratory trial on 100 adults aged 40 years or older with uncontrolled hypertension to optimize the design for a structured multi-component intervention in primary care clinics for management of hypertension.MethodsTwo clinics were involved, each enrolling 50 participants, with one as the intervention clinic and the other as the control (usual care). The intervention comprised the following four components: 1) an algorithm-driven intervention using a fixed-dose combination (FDC) antihypertensive treatment and lipid lowering medication for high risk individuals, 2) subsidized FDC antihypertensive medication; 3) motivational conversation (MC) for high risk individuals; and 4) telephone follow-ups of all individuals. The process outcomes were intervention fidelity measures. The outcomes of change in parameters of interest were healthy lifestyle index (composite score of body mass index, physical activity, dietary habit, dietary quality and smoking), adherence to antihypertensive medications, and systolic and diastolic BP from baseline to follow-up at 3 months.ResultsGreater than 90 % fidelity was achieved for 3 of the 4 intervention components. Although not designed for conclusive results, the healthy lifestyle score increased by 0.16 (±0.68) with the intervention and decreased by 0.18 (±0.75) with usual care (p = 0.02). Adherence to anti-hypertensive medications at follow-up was 95.3 % in the intervention group compared to 83.8 % for usual care (p = 0.01). Systolic and diastolic BP decreased in both intervention and control groups, although statistical significance between groups was not achieved. Hypertensive individuals rated all intervention components ‘highly favorable’ on a Likert scale.ConclusionsOur findings indicate that the proposed, structured multi-component approach for management of hypertension is feasible for implementation in primary care clinics in Singapore, with some changes to the protocol. The observed improvement in the healthy lifestyle index and adherence to anti-hypertensive medications is promising. A large scale, adequately powered trial would be informative to assess intervention effectiveness on BP and cardiovascular risk reduction.Trial registrationThis trial has been registered at ClinicalTrials.gov. ClinicalTrials.gov number NCT02330224. Registered on 28 December 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1491-6) contains supplementary material, which is available to authorized users.