INFLUENCE OF COMBINED THERAPY ON ARTERIAL HYPERTENSION IN PATIENTS WITH DIABETES MELITTUS TYPE 2
About the author:
Shelest B. O.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Proper control of blood pressure level is crucial for improving the prognosis of patients with diabetes mellitus type 2 (DM2T) with arterial hypertension (AH). Despite a wide range of antihypertensive drugs, the current problem of pharmacotherapy of hypertension in patients with diabetes and obesity remains pending. The aim of the study is to evaluate the antihypertensive efficacy of perindopril, telmisartan, indapamide and amlodipine in hypertensive patients combined with DM2T. Methods and materials. A total of 48 patients with type 2 diabetes, AH (stage II), and visceral obesity who did not receive pre-existing regular antihypertensive therapy at the age of 40 to 65, mean duration of DM2T – 5.32 ± 0.63, AG – 8.43 + 1.12, obesity – 11.37 ± 1.68 years. The initial mean for the group systolic blood pressure (BP) was 154.9 ± 3.43, diastolic blood pressure – 92.7 ± 1.12 mm Hg. Clinical diagnosis was established on the basis of patient complaints, anamnesis of the disease, objective examination data. Electrocardiography was used in the experimental methods, transthoracic echocardiography (apparatus «Philips HD11XE», USA), daily monitoring of blood pressure. The fasting blood glucose and postprandial blood glucose concentration was examined by a glucose oxidase method, the percentage of glycosylated hemoglobin was determined using Reagent test systems (Ukraine). Results and discussion. In the study group, the mean systolic blood pressure (SBP) load reached the value of 69.21 ± 1.43% in 24 hours, and the diastolic BP – 34.12 ± 1.64%. Attention was drawn to the insufficient degree of nocturnal depression of the SBP. The mean value of the daily index was 8.17 ± 0.78% in experimental group. At the same time, 52% of the patients had a violation of biphasic diurnal rhythm. Thus, 38% of patients had non-dippers type of daily curve, and 15% had night-pickers. In the first group (25 people) who took perindopril, indapamide and amlodipine therapy, in most patients (74.2%) a good antihypertensive effect was achieved with 10 mg perindopril once a day, and in 25.8% – 5 mg/day. After 12 weeks of therapy, there was a significant improvement in the daily monitoring of blood pressure: the average daily BP decreased by 16.3 mm Hg. st, and diastolic by 5.6 mm Hg. A significant reduction in blood pressure was noted in the second group. 84.5% patients took 40 mg of telmisartan once a day, 15.5% of patients received this medication at a daily dose of 20 mg. 12 weeks therapy was accompanied by significant decrease in blood pressure in the whole day. The mean 24-hour values of systolic blood pressure decreased by 10.2% (up to 134.59 ± 3.24 mm Hg), diastolic blood pressure decreased by 9.1% (to 81.28 ± 1.36 mm Hg). Regardless of the drug used, the negative dynamics of carbohydrate metabolism was not recorded. Conclusions. Perindopril, telmisartan, indapamide and amlodipine have a multidimensional corrective effect on the daily profile of arterial pressure in patients with diabetes mellitus type 2. This pharmacological combination reduces BP in optimal way all day long and normalizes the impaired two-phase daily rhythm of blood pressure.
arterial hypertension, diabetes mellitus, daily monitoring of arterial pressure, perindopril, telmisartan
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 2 (143), 2018 year, 242-245 pages, index UDK 616.379-008.64:616.12-008.331.1-085