COMPLEX TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AND ARTERIAL HYPERTENSION COMBINED WITH DYSLIPIDEMIA

Mamedova V. G.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The aim is to assess the efficacy and safety of statins and fibrates in the treatment of patients with coronary artery disease, hypertension and their combination with concomitant DL, taking into account changes in the structural and functional state of the myocardium and intracardiac hemodynamics. Methods. We examined 120 men with CHD, AH and combination of CHD and AH with concomitant DL aged 31 to 82 years (mean age 54.9+0.9 years). The duration of the disease CHD from 2 to 22 years, AH-from 1 to 28 years. The diagnosis of AH and CHD was established in accordance with the relevant clinical recommendations. All patients underwent General clinical and instrumental (ECG, Echocardiography) examination, determination of the total blood count and lipid spectrum in blood plasma. The total duration of therapy was 12-14 months. All patients before treatment were studied baseline heart rate, SAD and dad, ECG, intracardiac hemodynamics with the calculation of myocardial mass (MM) according to the formula Penn Convention, myocardial mass index relative to body surface area (IMM) (C normal values calculated for men up to 115 g/m2 , total blood count and lipid spectrum of blood plasma. After 12-14 months of receiving therapy, all studies were fully re-conducted. Results. All patients who made up the observation subgroups received therapy for the underlying disease (CHD, hypertension and their combination). Analysis of the results showed that on the background of therapy was noted positive clinical dynamics in 3 compare subgroups: greatly improved the health of patients (decreased headaches, feeling of heaviness in the occipital and frontal parts of the patients with AH and CHD combined with hypertension), decreased frequency of angina attacks, shortness of breath in patients with coronary artery disease. Connection to the treatment of the underlying disease as atorvastatin and fenofibrate led to normalization of the lipid composition of blood plasma. Comparative dynamics of blood PRESSURE, heart rate, and MM and IMM during therapy without lipid-lowering drugs demonstrated a significant decrease in SAD, dad and heart rate, WHILE mm and IMM significantly increased after therapy. In the subgroup with the connection to the basic therapy of atorvastin, there was also a decrease in SAD, dad and heart rate, while MM and IMM significantly decreased from the baseline values after therapy, while in the subgroups of AH and CHD+AH, this decrease was significant. When connected to the basic therapy of atorvastatin, along with a decrease in SAD, dad and heart rate after the course of therapy, there was a significant decrease in MM and IMM in patients with hypertension and with a combination of coronary artery disease and hypertension, indicating a very desirable effect of reverse heart remodeling. In addition, the connection of statins and fibrates to long-term basic therapy, along with a pronounced lipid-lowering effect, led to a significant improvement in diastolic heart function, apparently due to the improvement of LV myocardial metabolism in patients with coronary heart disease and hypertension with concomitant DL. Conclusion. The data obtained by us indicate the expediency of including both statins and fibrates in the combined therapy of patients with coronary heart disease and hypertension.

ischemic heart disease, arterial hypertension, myocardial remodeling, lipid metabolism, statins, fibrates.

1. Dobrovol’skij AV. Fiksirovannaja kombinacija amlodipina i atorvastatina v terapii pacientov s povyshennym riskom serdechno-sosudistyh zabolevanij: dostizhenija i perspektivy. RMZh. 2013;9:438-44. [in Russiаn].
2. Thomas MR, Lip GYH. Novel risk markers and risk assessments for cardiovascular disease (review). Circ. Res. 2017;6:133-49. DOI: 10.1161/ CIRCRESAHA.116. 309955
3.  Ivashkin VT, Kuznecov BN. Sovremennye principy antigipertenzivnoj terapii. Ter. Arhiv. 2012;2:69-75. [in Russiаn].
4. Blank B, LaSall J, Reeves M, Maroni J, Tarasenko L, Sun F. Single pill therapy in the treatment of concomitant hypertension and dyslipidemia (the atorvastatin/amlodipine Gemini study). J. Clin. Hypertens. 2015;7:264-73.
5. Diagnostika i lechenie arterial’noj gipertenzii. Nacional’nye klinicheskie rekomendacii. Sbornik (2-e izdanie). M.: izd-vo «Siliceja-Poligraf»; 2009. s. 292-332. [in Russiаn].
6. Diagnostika i lechenie hronicheskoj ishemicheskoj bolezni serdca (klinicheskie rekomendacii, razrabotannye po porucheniju Minzdrava Rossii i utverzhdennye Obshhestvom specialistov po neotlozhnoj kardiologii i profil’noj komissiej po kardiologii). 2013. 70 s. [in Russiаn].
7. Lang RM, Bierig M, Devereux RB, Flachskampf F, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Guidelines. Eur. J. Echocardiography. 2006;7(2):79-108.
8. Störk TV, Müller RM, Piske GJ, Ewert CO, Hochrein H. Noninvasive measurement of left ventricular filling pressures by means of transmitral pulsed Doppler ultrasound. Am. J. Cardiol. 1989;64(10):655-60.
9. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circ. 1977;55(4):613-8.
10. Du Bois D, Du Bois E. A formula to estimate the approximate surface area if height and weight be known. Arch. Intern. Med. 1916;17:863-71.
11. Shopin AN. Strukturno-funkcional’noe remodelirovanie serdca i ego prognosticheskoe znachenie u lic s mnozhestvennymi faktorami riska i bol’nyh ishemicheskoj bolezn’ju serdca [dissertatsiya]. Perm’: 2011. 195 s. [in Russiаn].
12. Klimov AN. Holesterin i kletka. Aktual’nye problemy patogeneza ateroskleroza. L.: NIIJeM; 1985. s. 26-47. [in Russiаn].

«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 139-144 pages, index UDK 616-08-0.31.81-616.1

10.29254/2077-4214-2019-4-2-154-139-144