APPLICATION OF THREE-COMPONENT ANTIHYPERTENSIVE THERAPY IN ESSENTIAL HYPERTENSION WITH OBESITY

Starchenko T., Penkova M., Mysnychenko O., Yushko K., Shkapo V., Lytvynova O.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Essential hypertension (EH) is one of the main independent risk factors for cardiovascular disease. A very significant association of EH with metabolic disorders, especially obesity, whose prevalence in the world is continuously increasing, is described. It is shown that one of the main conditions for reducing the development of cardiovascular complications is the achievement of target blood pressure (BP) levels in such patients. However, for the majority of patients with EH with abdominal obesity (AO), the achievement of target BP levels is not observed, which is associated with the use of inadequate antihypertensive therapy, both in the number of drugs and per dose. In this connection, the purpose of this work was to study the efficacy of non-fixed combination of perindopril, indapamide and amlodipine in patients with EH with AO. 23 patients with EH II stage and 2-3 grades with AO I-II degrees were examined. The examination of patients included clinical, laboratory and instrumental methods. The indicators of lipid and carbohydrate metabolism, uric acid levels and 24-hour BP monitoring indices were studied. Non-fixed combination of antihypertensive drugs was prescribed to all patients: perindopril, indapamide and amlodipine. The starting doses of the drugs were 4 mg for perindopril, 1.5 mg for indapamide and 5 mg for amlodipine. Patients were re-examined after 12 weeks of the treatment. In the cases of insufficient clinical effects of the drugs in the prescribed doses, during the first 2 to 3 weeks, their doses were gradually increased to optimal or maximum (8 mg for perindopril, 2.5 mg for indapamide and 10 mg for amlodipine). The target BP levels were the levels of systolic BP/diastolic BP <140/90 mm Hg. Atorvastatin was administered at a daily dose of 20 mg as hypolipidemic drug. A significant improvement in state of health in all examined patients in the dynamics of treatment was observed. The number of side effects was low. After appointment of this drugs combination the target BP levels at the end of treatment were in 65% of patients, reduction of BP by more than 10% compared with baseline values was observed in 12%, and in the rest of the patients BP did not change significantly. The compliance with the treatment was in 70% of patients. According to the 24- hour BP monitoring, a significant decreases of the average 24-hours, the average daily and the average night BP levels, pressure loading indices and the normalization of the daily profile of BP were observed in the dynamics of the treatment. As a result of the analysis of the dynamics of metabolic changes, a significant decrease in the frequency of dislipoproteinemia was found with no change of the frequency of initial disturbances of carbohydrate and purine metabolism. Analyzing of the group of patients with ineffective antihypertensive therapy (35%) discovered that 4 patients (17%) did not follow the recommendations, 2 patients (9%) only received perindopril 8 mg or amlodipine 5 mg, 2 patients (9%) did not take or took irregularly the medications. Thus, the using of the combination of different groups of antihypertensive drugs is sufficiently effective in the control of BP. The combination of perindopril, indapamide and amlodipine does not cause an impairing in carbohydrate and lipid metabolism. Potentiation of the hypotensive effects can increase the effectiveness of therapy in general and reduce the risk of adverse side effects.

essential hypertension, abdominal obesity, nonfixed-dose triple combination of antihypertensive drugs

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«Bulletin of problems biology and medicine» Issue 4 Part 3 (141), 2017 year, 235-238 pages, index UDK 616.12-008.331.1-085:616-056.52

10.29254/2077–4214–2017–4–3–141–235-238