Dual Antihypertensive Therapy Research Articles

Estimated impact of guidelines-based initiation of dual antihypertensive therapy on long-term cardiovascular outcomes in 1.1 million individuals.

Guidelines recommend initiation of dual combination antihypertensive therapy, preferably single-pill combination (SPC), in most patients with hypertension. Evidence on narrowing gaps in clinical practice relative to guidelines is limited. Monte Carlo simulation was applied to 1.1 million patients qualifying for dual combination therapy from a previously conducted retrospective analysis of clinical practice, hospital statistics, and national statistics in the UK. We provide 10-year Kaplan-Meier event rates for the primary endpoint representing a composite of nonfatal myocardial infarction, nonfatal stroke (ischemic or hemorrhagic), nonfatal heart failure hospitalization or cardiovascular death. Cox model results from a previously conducted study were utilized to estimate baseline risk, together with evidence on risk reduction from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) meta-analysis and published evidence on BP-lowering efficacy of antihypertensive therapies. In the overall population, estimated 10-year event rates for the primary endpoint in patients with 100% persistence in monotherapy were 17.0% for irbesartan (I) and 17.6% for ramipril (R). These rates were only modestly better than that observed in clinical practice (17.8%). In patients with 100% persistence in dual therapy, estimated event rates were 13.6% for combinations of Irbesartan+Amlodipine (ARR=8.7% compared to untreated) and 14.3% for Ramipril+Amlodipine (ARR=8.0% compared to untreated). The absolute risk of the primary endpoint was reduced by 15.9% in patients with ASCVD and 6.6% in those without ASCVD. Similarly, the absolute risk was reduced by 11.7% in diabetics and 7.8% in those without diabetes. This study represents the first to investigate guidelines-based treatment in hypertensive patients and demonstrates the opportunity for considerable risk reduction by ensuring recommended dual therapy in clinical practice, particularly in the form of SPC with high persistence, relative to no treatment or monotherapy.

Estimated impact of guidelines-based initiation of dual antihypertensive therapy on long-term cardiovascular outcomes in 1.1 million individuals.

Guidelines recommend initiation of dual combination antihypertensive therapy, preferably single-pill combination (SPC), in most patients with hypertension. Evidence on narrowing gaps in clinical practice relative to guidelines is limited. Monte Carlo simulation was applied to 1.1 million patients qualifying for dual combination therapy from a previously conducted retrospective analysis of clinical practice, hospital statistics, and national statistics in the UK. We provide 10-year Kaplan-Meier event rates for the primary endpoint representing a composite of nonfatal myocardial infarction, nonfatal stroke (ischemic or hemorrhagic), nonfatal heart failure hospitalization or cardiovascular death. Cox model results from a previously conducted study were utilized to estimate baseline risk, together with evidence on risk reduction from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) meta-analysis and published evidence on BP-lowering efficacy of antihypertensive therapies. In the overall population, estimated 10-year event rates for the primary endpoint in patients with 100% persistence in monotherapy were 17.0% for irbesartan (I) and 17.6% for ramipril (R). These rates were only modestly better than that observed in clinical practice (17.8%). In patients with 100% persistence in dual therapy, estimated event rates were 13.6% for combinations of Irbesartan+Amlodipine (ARR=8.7% compared to untreated) and 14.3% for Ramipril+Amlodipine (ARR=8.0% compared to untreated). The absolute risk of the primary endpoint was reduced by 15.9% in patients with ASCVD and 6.6% in those without ASCVD. Similarly, the absolute risk was reduced by 11.7% in diabetics and 7.8% in those without diabetes. This study represents the first to investigate guidelines-based treatment in hypertensive patients and demonstrates the opportunity for considerable risk reduction by ensuring recommended dual therapy in clinical practice, particularly in the form of SPC with high persistence, relative to no treatment or monotherapy.

Transverse arch stenting and its effect on systemic hypertension.

This study aimed to investigate the safety and efficacy of transverse aortic arch stenting and evaluate the course of hypertension and the act of arch stenting on systemic hypertension. The transverse aortic arch stenting procedures between January 2007 and May 2023 were retrospectively analyzed. Detailed procedure information, technical aspects, pressure measurements, angiographic data, balloons and stents used, complications, and immediate results were examined. Early and mid-term results were assessed. Eighteen patients (10 males and 8 females; mean age: 14.5±5.3 years; range, 4 to 23 years) were included in the study, all of whom were hypertensive before the procedure. The mean weight was 56.8±19.6 kg. In seven patients, the stent struts had to be dilated due to the stent causing jailing at the entrance of nearby arch vessels. After stenting, there was a significant increase in arch diameter and a decrease in ascending aorta pressure and the pressure gradient across the aorta. There were no early mortality or major complications. Late migration of the stent was observed in one patient. Three patients became normotensive immediately after the intervention, and five became drug-free during the follow-up. The requirement for dual antihypertensive therapy was significantly reduced. Residual transverse arch lesions may contribute to the persistence of systemic hypertension after coarctation treatment. Transverse arch stent implantation can be performed safely with favorable outcomes, facilitating better blood pressure control. However, it should be noted that these patients remain at risk for lifelong hypertension and should be closely monitored in this regard.

Triple fixed-dose combination of amlodipine, indapamide and perindopril for hypertension in patients with stable coronary artery disease and abdominal obesity

Aim. In an open-label clinical trial, to evaluate the effectiveness and impact on metabolic parameters of triple antihypertensive combination therapy with amlodipine, indapamide and perindopril arginine (perindopril A) in patients with hypertension (HTN) and stable coronary artery disease (CAD) in combination with abdominal obesity (AO), who have not had an adequate response to dual antihypertensive therapy for at least 4 weeks.Material and methods. The study included 68 adult patients aged 42 to 64 years (51 (47; 60) years) with AO, stable CAD and uncontrolled HTN, despite treatment with two drugs: an angiotensin-converting enzyme (ACE) inhibitor and a thiazide and thiazide-like diuretic. In the study, patients, in accordance with the general characteristics of the drug, after prescribing a free triple-dose combination of amlodipine, indapamide, perindopril in appropriate dosages, received one of the following combination of amlodipine/indapamide/perindopril for 24 weeks: group 1 (n=34) — 10/2,5/10 mg and group 2 (n=34) — 5/1,25/5 mg, one tablet daily. The analysis of the primary endpoint was to assess the change in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the sitting position from baseline to 24 weeks. Secondary efficacy endpoints included the proportion of patients achieving target mean SBP and DBP values for this category in the sitting position of 120-130 mm Hg and 70-79 mm Hg, respectively, at 12, 16, 20 and 24 weeks. Safety was assessed throughout the study. The effect on metabolic parameters was assessed at 24 weeks of the study.Results. Sixty-seven (98,5%) patients completed the study. The mean decrease in blood pressure from the initial level (group 1159/96 mm Hg; group 2161/95 mm Hg) to 24 weeks (group 1 126/76 mm Hg; group 2 132/84 mm Hg) was significant (p<0,0001 for all). The proportion of patients who reached the target mean values of SBP (120-130 mm Hg) and DBP (70-79 mm Hg) in the sitting position by 24 weeks was 80,16% and 79,28% in group 1, respectively; in group 2 — 65,32% and 70,06%, respectively. No serious adverse events were recorded. Its administration, regardless of the doses of individual components in combination, was accompanied not only by metabolic neutrality in relation to carbohydrate, lipid and purine metabolism, a decrease in chronic inflammation, but was also associated with a decrease in serum leptin concentration and subcutaneous adipose tissue, an increase in tissue sensitivity to leptin, as well as a decrease in the size of adipocytes in subcutaneous fat.Conclusion. Triple fixed-dose of amlodipine/indapamide/perindopril in two different dosages is effective, safe and well tolerated in patients with HTN and stable CAD in combination with AO.

Logistic regression model for predicting failure of dual antihypertensive therapy: a prospective comparative non-randomized clinical trial

Background. Initial dual antihypertensive therapy is currently considered as the first management step for the majority of patients with arterial hypertension. However, it often fails to achieve the target blood pressure levels. An approved algorithm for predicting the failure of dual antihypertensive therapy is still to be developed. Objectives. To establish predictors of dual antihypertensive therapy failure in patients with high and very high cardiovascular risk and to create a model for predicting negative outcome of dual antihypertensive therapy. Methods. The paper presents a prospective comparative non-randomized clinical trial. The recruiting of participants and recording of results were carried out in March–December 2019 with 3 months of the follow-up period. The trial involved examination of 88 patients with poor blood pressure control, stage II and III arterial hypertension, high and very high cardiovascular risk of stages 1–3. Clinical and laboratory examination was carried out in compliance with the current regulatory documents. Additional examination included tests for uric acid, high-sensitivity C-reactive protein, as well as respiratory polygraphy and computerized capillaroscopy. All patients were prescribed dual antihypertensive therapy. The primary search for predictors was performed using the binary logistic regression. The predictive model was developed by stepwise variable selection. The diagnostic significance of the binary classifier was assessed by means of ROC-curve analysis; the calculation was performed using MedCalc 20.218 software (MedCalc Software Ltd., Belgium). Results. Administration of two hypotensive drugs appears to be effective in 33% of patients. The final model for predicting negative outcomes of dual antihypertensive therapy included such independent predictors as interventricular septal thickness, daily mean systolic blood pressure, and area density of the capillary network. The odds ratio accounted for 9.1 (95% confidence interval 3.12; 26.82). The area under the ROC curve based on the multiple binary logistic regression model comprised 0.805±0.05 with 95% confidence interval: 0.707-0.882 (p<0.0001). The sensitivity and specificity of the method amounted to 83.1 and 69.0%, respectively. The prediction accuracy comprised 77.3%. Conclusion. The development of patient-oriented algorithms for selection of hypotensive treatment is considered to be essential due to poor blood pressure control during dual antihypertensive therapy. The developed prognostic model may be applied when managing hypertension.

PROSPECTS FOR INITIAL TRIPLE ANTIHYPERTENSIVE THERAPY

The currently recommended initial dual antihypertensive therapy (AHT) results in poor blood pressure (BP) control, whereas most patients should undergo triple-combination therapy to achieve target levels. We have found only foreign publications concerning initial triple antihypertensive treatment.
 The aim of the study is to compare the traditional step by step strategy of drug administration and application of three antihypertensive drugs simultaneously.
 Materials and Methods. Trial subjects were divided into 2 groups: patients who received conventional dual therapy followed by a third drug agent (n=59) and patients who received initial triple AHT (n=57). The frequency of prescribed drugs and their dosage were comparable. The examination was carried at hospital according to the current standards of medical care for hypertensive adults. Values <140/90 mm Hg were taken as BP target level. Office blood pressure was tested 1 and 3 months after the therapy. 24-hour BP control was carried out 12 weeks after treatment.
 Results. The analysis of cardiovascular risks (CVRs) did not reveal significant intergroup differences (p>0.05). Both treatment regimens demonstrated fewer complaints and a comparable frequency of adverse reactions (p>0.05). Intergroup comparison conducted 1 month after treatment showed lower SBP and DBP levels (p<0.001) and a significant decrease in blood pressure in the 2nd group compared to baseline (p<0.001). The chance of achieving BP target level with the traditional scheme was 0.20, while with the initial triple AHT it was 2.35. The odds ratio was 11.53 (95 % CI 4.76; 27.96).
 Conclusion. Initial triple antihypertensive therapy has an advantage over the conventional one due to faster achievement of BP target levels. Given the comparable efficacy and frequency of adverse reactions, the strategy may be of interest for further study and implementation in practical medicine.

THE ROLE OF PHYSICAL ACTIVITY IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

The study aimed to assess the impact of physical activity on the dynamics of neurohumoral and cardio hemodynamic indicators in patients with arterial hypertension and concomitant obesity under different pharmacotherapy regimens. Materials and Methods: Two hundred patients with stage II arterial hypertension grade 2 and obesity grade I–II were examined using clinical-anamnestic, anthropometric, biochemical, automated immunological analysis, spectrophotometric and instrumental methods. Per the research objective, patients underwent a re-evaluation after six months of prescribed treatment. Non-pharmacological treatment included dietary therapy aimed at weight correction, with recommendations to increase physical activity primarily through brisk or moderately brisk walking for at least 45 minutes daily. Pharmacological treatment followed the European recommendations in 2018, involving dual antihypertensive therapy. The combination included perindopril and amlodipine. Patients who achieved target BP levels within 3 months of treatment continued to receive the prescribed therapy. For the rest of the patients, a third antihypertensive drug, indapamide, was additionally prescribed. In addition to assessing the achievement of target blood pressure levels after 6 months and at interim stages of the study, patients' adherence to recommendations regarding expanding physical activity was evaluated. Patients were divided into groups with sufficient and reduced physical activity accordingly. Statistical analysis of the obtained data was conducted using the SPSS 17 software package (IBM), Microsoft Office Excel-2003. The data are presented as mean values ± standard deviation. Significance was established at the level of p < 0.05 in all cases. Results of the study: Patients who achieved target blood pressure levels on dual antihypertensive therapy and had sufficient physical activity after six months of treatment differed significantly from patients with low physical activity levels. They exhibited lower values of the pulse wave velocity in the carotid artery and abdominal aorta, a considerably higher degree of endothelium-dependent vasodilation, lower values of end-systolic and end-diastolic diameters, left ventricular mass, a lower E/e´ ratio, and showed better dynamics in metabolic and pro-inflammatory indicators. Additionally, they had a higher level of antioxidant protection. Patients who reached the target blood pressure levels on three-component antihypertensive therapy and engaged in sufficient physical activity after six months displayed significant differences compared to patients with low physical activity. These differences included a more substantial reduction in the pulse wave velocity in the carotid artery, an increase in endothelium-dependent vasodilation, lower indicators of carbohydrate metabolism, reduced levels of pro-inflammatory and pro-oxidant activity, lower levels of leptin, and a more pronounced increase in adiponectin. Conclusions: Physical activity is a crucial factor influencing the treatment outcomes for patients with arterial hypertension and obesity across different antihypertensive therapy regimens. Irrespective of the chosen antihypertensive therapy option, physical activity positively impacted cardiovascular remodelling, the dynamics of metabolic and pro-inflammatory indicators, and the equilibrium within the oxidative stress-antioxidant protection system and activity of the renin-angiotensin-aldosterone system.

Antihypertensive treatment: the winning combination

Detecting, treating and controlling hypertension remains a primary goal in health policy. New recommendations in the management of hypertension were published in 2023 to withhold its global pandemic. The first step is to initiate dual antihypertensive therapy in most of the cases by combining 2 molecules from different classes in a single tablet. Subsequent steps involve ensuring blood pressure control and, if indicated, combining other drug classes, again as a single pill combination (SPC). These polypills make it possible to reduce blood pressure more effectively, to offer earlier cardioprotection and to increase patient's compliance while simplifying their treatment and eliminating adverse effects. In this article, we will focus on the combination of antihypertensive classes as a revolutionary paradigm.

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India.

This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31-50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin-angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

BLOOD PRESSURE CONTROL WITH BITHERAPY VERSUS MONOTHERAPY IN OLDER PATIENTS IN THE AREA OF BLIDA (ALGERIA)

Objective: To describe hypertensive subjects over 60 years old, according to their bioclinical characteristics and their treatments by comparing monotherapy and combination therapy. Design and method: This is a cross-sectional study of 120 hypertensive patients aged over 60 between January 2021 and May 2021. The data were collected with a pre-established information sheet, from standardized files. Results: The mean age of the patients was 69,85 ± 7,82 years, 68 (56,7%) of the patients were men. The mean systolic/diastolic blood pressure was (137,45/76,06 ± 17,24/10.13 mmHg). The majority of patients (70%) were treated with dual antihypertensive therapy. The ARBs was the most prescribed class (72,5%). BP was controlled (reduced to < 140/90 mm Hg) in (64; 53,33%) patients, of whom 64,04% were on combination therapy. The comparison between the two groups under monotherapy and combination therapy was without significant difference. Conclusions: Few patients are treated with monotherapy, which reflects the recommendations of the European guidelines to treat with combination therapy. In summary, this study confirms the effectiveness of combination therapy for blood pressure control in the elderly.

Study of Antihypertensive Use in Elderly Subjects with or Without Comorbid Conditions in A Tertiary Care Hospital

Hypertension is the commonest cardiovascular disorder, with the prevalence progressively increasing with age and elderly subjects are more prone for various hypertension-related complications. Presence of various co-morbid conditions influences the choice and dose of antihypertensive medications. Persistent adherence to the prescribed medications and lifestyle measures are very essential to reduce the morbidity and mortality, and to improve the QOL. The objective of the study is to determine the pattern of antihypertensive prescribing, to assess the medication compliance and Quality of life. 250 elderly hypertensive subjects of either gender were recruited in to the present study to assess the prescribing pattern of antihypertensives; details of drug therapy, therapeutic class, dose, route, frequency, duration of administration. The compliance was 8-item questionnaire as per Morisky Medication Adherence Scale and the Quality of life was assessed using MINICHAL Instrument, consisting of 17-item questionnaire. The most commonly prescribed antihypertensives were angiotensin receptor blockers (55%) and calcium channel blockers (55%) and, angiotensin receptor blocker + thiazide diuretic combination was the commonest dual antihypertensive therapy prescribed. 41.2% subjects had good level of medication compliance, 48.4% subjects had moderate level of compliance and 10.4 % subjects had poor level of compliance. The mean total scores of the HRQoL scale in the subjects with pre hypertension was 26.20±8.01, 25.66±9.38 in subjects with stage 1 HTN and 29.36±8.66 in subjects with stage 2 HTN. The most common antihypertensives were angiotensin receptor blockers and calcium channel blockers. The level of compliance was influenced by factors such as age, gender, co morbidities, severity of hypertension and number of medications. HRQoL of the study population was influenced by severity of hypertension.

Effectiveness of a clinical decision support system for hypertension management in primary care: study protocol for a pragmatic cluster-randomized controlled trial

BackgroundClinical decision support systems (CDSS) are low-cost, scalable tools with the potential to improve guideline-based antihypertensive treatment in primary care, but their effectiveness needs to be tested, especially in low- and middle-income countries such as China.MethodsThe Learning Implementation of Guideline-based decision support system for Hypertension Treatment (LIGHT) trial is a pragmatic, four-stage, cluster-randomized trial conducted in 94 primary care sites in China. For each city-based stage, sites are randomly assigned to either implementation of the CDSS for hypertension management (which guides doctors’ treatment recommendations based on measured blood pressure and patient characteristics), or usual care. Patients are enrolled during the first 3 months after site randomization and followed for 9 months. The primary outcome is the proportion of hypertension management visits at which guideline-based treatment is provided.In a nested trial conducted within the CDSS, with the patient as the unit of randomization, the LIGHT-ACD trial, patients are randomized to receive different initial mono- or dual-antihypertensive therapy. The primary outcome of the LIGHT-ACD trial is the changes in blood pressure.DiscussionThe LIGHT trial will provide evidence on the effectiveness of a CDSS for improving guideline adherence for hypertension management in primary care in China. The nested trial, the LIGHT-ACD trial, will provide data on the effect of different initial antihypertensive regimens for blood pressure management in this setting.Trial registrationClinicalTrials.gov, identifier: LIGHT (NCT03636334) and LIGHT-ACD (NCT03587103). Registered on 3 July 2018.

Personalized management of hypertensive patients: focus on prognostic biomarkers

Aim. To analyze level of circulating biomarkers of plasma vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) during 3-month therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24, AO Vertex, Russia), as well as to evaluate the antihypertensive efficacy of a fixed-dose combination of ramipril/indapamide (Konsilar-D24, JSC “Vertex”, Russia) in hypertensive (HTN) patients with type 2 diabetes (T2D).Material and methods. This prospective open-label study included 44 patients (aged 35 to 60 years) of both sexes with essential grade 1-2 HTN and concomitant compensated T2D, who did not reach the target blood pressure (BP) level using single or dual antihypertensive therapy, as well as patients who did not take antihypertensives. All patients included in the study initially underwent a set of standard clinical, laboratory and functional examinations in accordance with the clinical guidelines for the management of patients with HTN and T2D, as well as an assessment of the level of C-reactive protein, VEGF and TNF-α. Patients were monitored and treated with Konsilar-D24 for 3 months.Results. In 93,2% of patients, individual target BP values were achieved during the first 2-4 weeks of therapy with a fixed combination of ramipril/indapamide (Konsilar-D24). In the subsequent 3-month follow-up, the average daily BP level in all patients ranged from 129/79 mm Hg to 110/70 mm Hg. Three-month Konsilar-D24 therapy showed a decrease in microalbuminuria: the median values of microalbuminuria decreased by 2 times, and the decrease in the maximum recorded values reached 40% of the baseline. Decrease in mean TNF-α values after 3-month therapy with Konsilar-D24 was 33% of the baseline values, while the maximum recorded values during the specified period decreased by 17%. Decrease in median VEGF values after 3-month Konsilar-D24 therapy was 28%, while the maximum value decreased by 7%, the minimum — by 8%.Conclusion. Konsilar-D24 improves the prognosis in hypertensive patients not only by reducing BP to target values, but also by reducing the level of VEGF and TNF-α biomarkers that determine the progression of endothelial dysfunction, diabetic retinopathy, and microalbuminuria.

Personalized management of hypertensive patients: focus on prognostic biomarkers

Aim. To analyze level of circulating biomarkers of plasma vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) during 3-month therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24, AO Vertex, Russia), as well as to evaluate the antihypertensive efficacy of a fixed-dose combination of ramipril/indapamide (Konsilar-D24, JSC “Vertex”, Russia) in hypertensive (HTN) patients with type 2 diabetes (T2D).Material and methods. This prospective open-label study included 44 patients (aged 35 to 60 years) of both sexes with essential grade 1-2 HTN and concomitant compensated T2D, who did not reach the target blood pressure (BP) level using single or dual antihypertensive therapy, as well as patients who did not take antihypertensives. All patients included in the study initially underwent a set of standard clinical, laboratory and functional examinations in accordance with the clinical guidelines for the management of patients with HTN and T2D, as well as an assessment of the level of C-reactive protein, VEGF and TNF-α. Patients were monitored and treated with Konsilar-D24 for 3 months.Results. In 93,2% of patients, individual target BP values were achieved during the first 2-4 weeks of therapy with a fixed combination of ramipril/indapamide (Konsilar-D24). In the subsequent 3-month follow-up, the average daily BP level in all patients ranged from 129/79 mm Hg to 110/70 mm Hg. Three-month Konsilar-D24 therapy showed a decrease in microalbuminuria: the median values of microalbuminuria decreased by 2 times, and the decrease in the maximum recorded values reached 40% of the baseline. Decrease in mean TNF-α values after 3-month therapy with Konsilar-D24 was 33% of the baseline values, while the maximum recorded values during the specified period decreased by 17%. Decrease in median VEGF values after 3-month Konsilar-D24 therapy was 28%, while the maximum value decreased by 7%, the minimum — by 8%.Conclusion. Konsilar-D24 improves the prognosis in hypertensive patients not only by reducing BP to target values, but also by reducing the level of VEGF and TNF-α biomarkers that determine the progression of endothelial dysfunction, diabetic retinopathy, and microalbuminuria.

Practical efficacy and safety of Konsilar D24 in patients with hypertension: data from the KONSONANS program

Aim. In practice, to evaluate the efficacy, safety and long-term adherence to therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24) in patients with grade 1-2 hypertension (HTN) who have not achieved blood pressure (BP) control with prior therapy or have not taken antihypertensive therapy.Material and methods. This multicenter open-label observational program included 524 patients with grade 1-2 HTN who did not take antihypertensive therapy or did not reach the target BP level with mono or dual antihypertensive therapy, as well as patients shifted to Konsilar-D24 therapy no later than two weeks before the start of the program. All patients signed a written informed consent to participate in the program. The safety analysis set includes all patients who have taken at least one dose of a fixed-dose combination of ramipril/indapamide and have visited physician at least once during the program. The effectiveness analysis set included all patients in the safety population who completed the study in accordance with protocol (n=511). Clinical systolic blood pressure (SBP), diastolic BP (DBP) and heart rate were assessed at baseline, as well as at 0,5, 1, 3 and 6 months of treatment. A post hoc subgroup analysis of changes in BP and heart rate was performed depending on age, sex and baseline body mass index.Results. The fixed-dose combination of ramipril with indapamide significantly reduced SBP and DBP after 2-week treatment (-20,9±10,1 mm Hg; pConclusion. Despite the limitations inherent in observational studies, the KONSONANS program has demonstrated high efficacy and safety of fixed-dose combination of ramipril/indapamide taken once a day in hypertensive patients. Ramipril/indapamide fixed-dose combination therapy significantly improved BP control and achieved even lower individual target BP levels in the majority of hypertensive patients.

FEATURES OF METABOLIC AND HEMODYNAMIC INDICATORS IN OBESE PATIENTS WITH RESISTANT HYPERTENSION

Objective: To establish the features of metabolic and hemodynamic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Design and method: The study included 200 patients with AH grade II and obesity I-II classes (age 45–55 years). Patients were initially prescribed dual antihypertensive therapy (ACEI and CCB). Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally assigned a third antihypertensive drug (indapamide). Of the 98 patients who were assigned triple therapy, 48 patients did not reach target BP levels: 27 patients had pseudo-resistant AH (due to low compliance with treatment and insufficient adherence to the physician's instructions to ensure adequate levels of physical activity), and 21 patients had true resistant AH (did not have target BP levels with triple antihypertensive therapy and sufficient physical activity). These patients were additionally prescribed spironolactone. The effectiveness of the treatment in all groups was evaluated 6 months after the start of antihypertensive therapy. Results: Comparative assessment of obese patients in the presence and absence of resistant AH after 6 months of therapy showed that, unlike patients without resistance, individuals with resistant AH differed more pronounced cardiovascular remodeling and metabolic disorders, greater dysbalance of oxidative stress-antioxidant protection, greater proinflammatory activity and higher activity of the RAAS. When performing a comparative evaluation of the indicators in patients with pseudo-resistant and true resistant AH, it was found that patients with true resistance differed from pseudo-resistant patients with significantly lower (p = 0.0229) body mass index (BMI). In addition, in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone (p = 0.0449), higher activity of oxidative stress system (malondialdehyde, p = 0.0055 and diene conjugates, p = 0.0299), lower levels of general antioxidant protection (p = 0.0004), higher adiponectin levels (p = 0.0000), and lower leptin level (p = 0.0001), compared to pseudo-resistant patients Conclusions: Obese patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone level, higher activity of the oxidative stress system, lower activity of the antioxidant protection system, higher adiponectin level, and lower leptin level.

Starting Antihypertensive Drug Treatment With Combination Therapy

Starting Antihypertensive Drug Treatment With Combination Therapy

Impact of Therapeutic Inertia on Long-Term Blood Pressure Control: A Monte Carlo Simulation Study.

[Figure: see text].

Efficiency of remote blood pressure monitoring in outpatients with hypertension: a pilot project in a city ambulatory care clinic

Aim. In a pilot project, to evaluate the effectiveness of remote blood pressure (BP) monitoring in outpatients followed up for hypertension (HTN).Material and methods. A total of 1,121 patients (707 women and 414 men) with hypertension were included in the pilot project (mean age, 52,0±12,0 years; BP, 151,4±9,1/96,9±10,3 mm Hg). Patients independently measured BP and entered the values into self-management paper diaries (n=886), in digital form to their personal account (n=200), or transmitted data from BP monitor using installed mobile application (n=35). Each of the three groups was assessed at baseline and after 6 months. We assessed achievement of BP targets, medication adherence using the Morisky Green scale, the prevalence of patients with fixed-dose antihypertensive therapy, and the ambulance call rate.Results. Prior to the study, 15,2% (n=171) of hypertensive patients regularly monitored their BP. After 6 months, the mean systolic BP decreased from 151,4±9,1 to 135,5±10,1 mm Hg (p<0,01), diastolic BP — from 96,9±10,3 to 85,8±6,3 mm Hg (p<0,01). The proportion of patients adhering to treatment (Morisky Green score of 4) increased from 17,9 to 55,4%, the frequency of prescribing dual antihypertensive therapy — from 25,8 to 43,3%, triple therapy — from 11,5 to 22,9%, fixed-dose combinations — from 25,4 to 51,6%. At the same time, the proportion of patients who achieved the target BP values increased from 14,5 to 43,1%, while the ambulance call rate decreased from 19,3 to 16,9%.Conclusion. The use of remote BP monitoring methods, including BP monitors with automated data transmission, increases the prescription rate of combined antihypertensive therapy and proportion of patients who achieved the target BP, as well as decreases the ambulance call rate.

Image and clinical analysis of common carotid web: a case report

BackgroundA carotid web is a very rare vascular disease of the carotid artery, leading to thrombosis and ischemic stroke.Case presentationA 65-year-old male patient was admitted due to left limb weakness. On arrival, he had moderate left hemiplegia, neglect, and sensory loss; the National Institutes of Health Stroke Scale score was 8. Computed tomography angiography (CTA) and magnetic resonance (MR) examination were performed to determine the cause of basal ganglia infarction. Thin-section axial CTA showed a membrane-like structure in the posterior wall of the right common carotid artery. The sagittal reconstruction image showed a membrane-like protrusion in the posterior wall of the right common carotid artery under the right carotid sinus. The MR axial T2 image showed a membrane-like high-signal protrusion into the carotid artery lumen, which was diagnosed as a right carotid web. The patient was treated with dual antihypertensive therapy by adjusting blood pressure, controlling brain edema, improving cerebral circulation, and nourishing the nerves.ConclusionCareful comparison of axial thin-layer CTA and MR axial T2 images combined with sagittal reconstruction of CTA images can greatly improve the diagnostic rate of carotid web.