scholarly journals Prospects of combined antihypertensive-psychocorrective therapy in women with arterial hypertension and anxiety-depressive disorders: clinical randomized placebo uncontrolled trial

2021 ◽  
Vol 28 (3) ◽  
pp. 61-77
Author(s):  
V. V. Skibitskiy ◽  
Yu. E. Ginter ◽  
A. V. Fendrikova ◽  
D. V. Sirotenko
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Depressive Disorders ◽  
Blood Pressure Monitoring ◽  
Aortic Pressure ◽  
Vascular Stiffness ◽  
Organ Injury ◽  
Severe Illness ◽  
Antidepressant Use

Background. Anxiety-depressive disorders (ADD) afflict almost half of patients with arterial hypertension (AH). AH aggravation by psychoemotional disorders causes a more severe illness and rapid target organ injury, particularly, the increased arterial stiffness and central aortic pressure (CAP). However, the prospects of combined antihypertensive-antidepressant treatments in AH-ADD patients remain largely unexplored.Objectives. The effect assessment in combined antihypertensive-psychocorrective therapy on circadian blood pressure (BP), vascular stiffness and CAP, anxiety and depression in women with AH and ADD.Methods. The study enrolled 60 AH-ADD women randomised between two cohorts. Cohort 1 received a fixed combination of valsartan and hydrochlorothiazide, bisoprolol and sertraline antidepressant; cohort 2 only had same combined AH therapy. Past 24 weeks of trial, all patients had a general clinical examination and daily blood pressure monitoring (DBPM) with BpLab Vasotens (Petr Telegin Ltd., Russia) and control of daily BP, CAP and vascular stiffness. The psychometric HADS and CES-D scales were used along with psychiatric counselling.Results. Past four weeks of treatment, the target blood pressure (TBP) was revealed in 60 and 36.7% patients, and in 90 and 66.6% — past eight weeks in cohorts 1 and 2, respectively. Cohort 1 vs. 2 required a lower valsartan dose to attain TBP. Past six months, both cohorts showed improved main DBPM values reflecting vascular stiffness and CAP. However, a statistical decrease in nocturnal central and peripheral BP, as well as improved BP variability and vascular stiffness were registered at antidepressant use. A normalised daily BP profile was significantly more frequent in cohort 1. In addition, sertraline had a significant ADD-reductive impact.Conclusion. An antidepressant-combined conventional AH therapy in AH-ADD women facilitated a faster TBP achievement at lower AH agent doses and the significantly improved DBPM (nocturnal specifically), arterial stiffness and CAP values. A sertraline treatment improved the psychoemotional patient state.

scholarly journals Effectiveness of Chrono-Pharmacotherapy Depending on the Salt Sensitivity of Patients with Arterial Hypertension and Diabetes Mellitus Type 2

2019 ◽  
Vol 14 (6) ◽  
pp. 846-851
Author(s):  
V. V. Skibitskiy ◽  
A. A. Kiselev ◽  
A. V. Fendrikova
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Arterial Stiffness ◽  
Diabetes Mellitus Type 2 ◽  
Blood Pressure Monitoring ◽  
Aortic Pressure ◽  
Diabetes Mellitus Type ◽  
Pressure Monitoring ◽  
Central Aortic Pressure

Aim. To study the effect of two regimens of combined antihypertensive therapy during the day on daily monitoring of arterial pressure, central aortic pressure, and arterial stiffness, depending on the salt sensitivity of hypertensive patients with diabetes mellitus type 2. Material and methods. 130 hypertensive patients with type 2 diabetes mellitus were included into the study. They were divided into 2 subgroups: salt-sensitive (group 1) and salt-resistant (group 2), and then randomized to subgroups A and B of ongoing therapy: in the morning ramipril and indapamide retard, bedtime – amlodipine (subgroup 1A and 2A); or in the morning amlodipine and indapamide retard, bedtime – ramipril (subgroup 1B and 2B). Initially and after 24 weeks of antihypertensive therapy, 24-hour blood pressure monitoring was performed, the indices of central aortic pressure and arterial stiffness were determined. Results. After 24 weeks, in all subgroups, there was a significant positive dynamics of the parameters of 24-hour blood pressure monitoring, central aortic pressure and arterial stiffness indices. In the subgroup 1В, it was registered a significant improvement in the majority of parameters of 24-hour blood pressure monitoring (decrease in 24-hours systolic BP by 24.4%, 24-hours diastolic BP by 22.1%; p<0.05), central aortic pressure (decrease in aortal systolic BP by 15.9%, aortal diastolic BP by 20.8%; p<0.05) and vascular wall stiffness parameters (decrease in pulse wave velocity by 13.8%; p<0.05) in comparison with group 1A (decrease in 24-hours systolic BP by 17.5%, 24-hours diastolic BP by 14.6%, aortal systolic BP by 12.7%, aortal diastolic BP by 9.7%, pulse wave velocity by 9.2%; p<0.05 in comparison with the group 1B). In the case of salt-resistant patients, there were comparable positive changes in the parameters of 24-hour blood pressure monitoring, central aortic pressure and arterial stiffness indices against the background of both dosing regimens during the day. Conclusion. In the study, it was demonstrated the more pronounced antihypertensive and vasoprotective efficacy of the combination of thiazide-like diuretic with calcium channel blocker in the morning and ACE inhibitor in bedtime compared to the alternative regimen of prescribed pharmacotherapy in salt-sensitive patients, and comparable efficacy of both regimens in salt-resistant hypertensive patients with diabetes mellitus type 2.

scholarly journals The Impact of Valsartan/Amlodipine Single-Pill Combination on Blood Pressure and Vascular Stiffness in Patients with Grade 1-2 Essential Arterial Hypertension

2019 ◽  
Vol 14 (6) ◽  
pp. 831-839
Author(s):  
E. V. Borisova ◽  
A. I. Kochetkov ◽  
O. D. Ostroumova
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Vascular Stiffness ◽  
Stage Ii ◽  
Ambulatory Bp Monitoring ◽  
Single Pill ◽  
Essential Arterial Hypertension ◽  
The Impact

Aim. To investigate the impact of valsartan/amlodipine single-pill combination (V/A SPC) on arterial stiffness parameters and 24-hours blood pressure (BP) level in the middle-aged patients with stage II grade 1-2 essential arterial hypertension (HT). Material and methods. A group of patients with stage II grade 1-2 HT who had not previously received regular antihypertensive therapy (n=38, age 49.7±7.0 years) was retrospectively formed. All the patients were treated with V/A SPC and all of them achieved target office BP (<140/90 mm Hg). 12 weeks after reaching the target BP the assessment of V/A SPC therapy effectiveness and vascular stiffness (general clinical data, ambulatory BP monitoring, volume sphygmography, echocardiography) were performed in all included HT patients. Sex- and age-matched healthy people with normal BP (n=86, age 48.8±5.8years) and in whom similar clinical and vascular stiffness data were available represented a control group. Results. According to the ambulatory BP monitoring data systolic, diastolic and pulse BP significantly (p<0.001) decreased after the treatment with V/A SPC. Volume sphygmography has showed significant decrease in right-CAVI value from 8.9±1.3 to 7.3±1.4 (p=0.021) as well as a reduction the number of patients with a right- and/or left-CAVI>9.0 from 31.6 to 10.5% (p=0,049). According to an assessment of arterial stiffness the augmentation index decreased significantly by 23.6±8.6% from -23.0±17.1 to -28.9±18.7 (p=0.034. Transthoracic echocardiography data has demonstrated decrease in effective arterial elastance from 1.73±0.35 to 1.60±0.32 mm Hg (p=0.016) and increase in the arterial compliance – from 1.30±0.38 to 1.43±0.34 mm Hg/ml (p=0.049). Conclusions. In naive patients 40-65 years old with stage II grade 1-2 HT antihypertensive therapy with V/A SPC provides effective 24 hours BP control and improves arterial stiffness parameters.

scholarly journals Antihypertensive and Vasoprotective Effects of Combined Pharmacotherapy in Patients with Arterial Hypertension and Prediabetes

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 10-17
Author(s):  
V. V. Skibitskiy ◽  
S. R. Gutova ◽  
A. V. Fendrikova ◽  
A. V. Skibitskiy
Keyword(s):  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Aortic Pressure ◽  
Combination Drug ◽  
Treatment Groups ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim To evaluate effects of different types of combination drug therapy on indexes of 24-h blood pressure monitoring (24-h BPM), arterial stiffness, and central aortic pressure (CAP) in patients with arterial hypertension (AH) and prediabetes.Materials and methods The study included 120 patients with AH and prediabetes. After randomization using envelopes, three treatment groups were formed: group 1, patients receiving perindopril, indapamide SR, and metformin (n=40); group 2, patients receiving perindopril, moxonidin, and metformin (n=40); and group 3, patients receiving perindopril, indapamide SR, and amlodipine (n=40). 24-h BPM, determination of arterial stiffness, and measurement of CAP were performed for all patients.Results After 24 weeks of treatment, patients of all groups showed statistically significant improvements of most indexes of 24-h BPM, arterial stiffness, and CAP. In groups 2 and 3, the treatment was associated with significantly more pronounced beneficial changes in 24-BPM, arterial stiffness, and CAP compared to group 1. Antihypertensive and vasoprotective effects of the perindopril+moxonidin+metformin and perindopril+indopamide SR+amlodipine combinations were comparable.Conclusion The observed statistically significant antihypertensive and vasoprotective effects of the perindopril+moxonidin+metformin combination along with its known positive metabolic effect allow recommendation of this combination therapy to patients with AH and prediabetes as an effective strategy for BP control.

scholarly journals Association between H-type arterial hypertension and vascular stiffness (a pilot study)

2021 ◽  
Vol 23 (1) ◽  
pp. 32-41
Author(s):  
Yu. M. Sirenko ◽  
O. L. Rekovets ◽  
O. O. Torbas ◽  
S. M. Kushnir ◽  
O. Yu. Sirenko
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Blood Pressure Level ◽  
Vascular Wall ◽  
Vascular Stiffness ◽  
Wall Stiffness ◽  
Body Weights ◽  
Total Homocysteine ◽  
The Relationship

Increased arterial stiffness is an important determinant of cardiovascular risk. Elevated total homocysteine (HC) levels appeared to be an independent risk factor for cardiovascular disease (CVD). To date, clinical studies on the relationship between HC and pulse wave velocity (PWV) assessment have shown conflicting results. Aim. To estimate the prevalence of hyperhomocystinemia (HHc) among patients with mild to moderate arterial hypertension and the effect of HHc on the vascular wall stiffness. Materials and methods. Our study was carried out as a part of the HYPSTER study in Ukraine. The study included 40 patients with I and II degree of arterial hypertension (AH) (average office systolic blood pressure (SBP)/diastolic (DBP) – 155.88/92.60 ± 1.63/1.43 mm Hg), heart rate – 71.40 ± 1.29 beats/min. The average age of the patients was 55.85 ± 2.09 (26–74) years. Patients with HC levels ≥10 μmol/l were defined as patients with H-type AH (HHc). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 % (30 patients with mild and moderate hypertension) had H-type hypertension with an increased level of HC. Patients with H-type AH and AH patients without HHc did not differ in age and AH duration. At the same time, patients with H-type AH had higher body weights and BMI. Office SBP in patients with H-type hypertension was higher compared to patients without HHc (156.45 ± 1.04 mm Hg vs. 152.55 ± 1.41 mm Hg at the beginning (P < 0.05) and 130.65 ± 0.96 mm Hg vs. 126.97 ± 1.08 mm Hg after 6 months (P < 0.05)) of treatment, respectively. BMI in H-type AH was 30.72 ± 0,39 kg/m2 vs. 28.34 ± 0.69 kg/m2 without HHc (P < 0.05) at the beginning of the study. It was difficult to achieve target levels of BP in the patients with H-type hypertension during the treatment and they had high initial blood pressure values. In contrast to the patients without HHc, H-type AH patients had a more pronounced degree of insulin resistance (according to the HOMA index), lower GFR both at the beginning and at the end of the treatment. According to ambulatory BP monitoring, H-type AH patients presented with a significantly higher SBP level before starting the treatment compared to those with AH without HHc. The regression analysis revealed an association between HC and PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, β = 0.307, P = 0.001). Conclusions. Hyperhomocystinemia was observed in 75 % of patients with arterial hypertension. Homocysteine levels were associated with vascular stiffness, regardless of the reduction in blood pressure level.

Ambulatory blood pressure monitoring-based definition of true arterial hypertension

2020 ◽  
Vol 111 (6) ◽  
Author(s):  
Ramón C. Hermida ◽  
Artemio Mojón ◽  
José R. Fernández ◽  
Alfonso Otero ◽  
Juan J. Crespo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Definition Of

scholarly journals The Key Role of Ambulatory Blood Pressure Monitoring in the Detection of Masked Hypertension and Other Phenomena in Frail Geriatric Patients

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1221
Author(s):  
Marek Koudelka ◽  
Eliška Sovová
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Geriatric Patients ◽  
Blood Pressure Monitoring ◽  
Target Range ◽  
Masked Hypertension ◽  
Pressure Monitoring

Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.

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