scholarly journals THE FREQUENCY OF USE OF COMBINATIONS OF ANTIHYPERTENSIVE DRUGS IN PATIENTS WITH DIFFICULT-TO-CONTROL HYPERTENSION ON THE BACKGROUND OF BIOFEEDBACK AND PACED BREATHING AND HEART RATE VARIABILITY

2018 ◽  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Drug Therapy ◽  
Arterial Hypertension ◽  
Antihypertensive Effect ◽  
Antihypertensive Drugs ◽  
Basic Subgroup ◽  
Paced Breathing ◽  
Frequency Of Use

The frequency of administration of combinations of antihypertensive drugs and its changes at different stages of observation was studied in 60 patients with difficult-to-control arterial hypertension (DTCAH) (32 men and 28 women) aged 59.0 ± 9.4. All patients were randomly divided into two subgroups: biofeedback (BFB) in the loop of paced breathing (PB) and heart rate variability (HRV) (33 patients) – basic subgroup, subgroup of comparisons (27 patients). Determined that patients with DTCAH in the subgroup of patients with the BFB in the loop of PB there has been a reduction of four-component antihypertensive therapy to three-component and in the subgroup of comparisons the frequency of the appointment of a four-component therapy was increased. At the same time, it was found that the addition of drug therapy with regular BFB sessions in the loop of PB contributed to the potentiation of the antihypertensive effect in patients with DTCAH. It is concluded that the BFB in the loop of PB and HRV can be used as a technology to improve the efficiency of control of blood pressure in patients with DTCAH.

scholarly journals A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease

2022 ◽  
Vol 28 (1) ◽  
Author(s):  
Linda P. Bolin ◽  
Amelia D. Saul ◽  
Lauren L. Bethune Scroggs ◽  
Carolyn Horne
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pilot Study ◽  
Family History ◽  
Diastolic Blood Pressure ◽  
Biofeedback Training ◽  
Paced Breathing ◽  
History Of

Abstract Background Cardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease. Methods Thirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic. Results The participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. Conclusions The findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability.

Effect of moderate physical exercises on the relationship of variability of the heart rhythm with the level of blood pressure and hemodynamic functions in women with essential hypertension

2021 ◽  
pp. 10-21
Author(s):  
Е.С. Гусева ◽  
С.О. Давыдов ◽  
Б.И. Кузник ◽  
Ю.Н. Смоляков ◽  
П.П. Терешков ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Essential Hypertension ◽  
Drug Therapy ◽  
Light Scattering ◽  
Dynamic Light Scattering ◽  
Hemostatic System ◽  
Hemodynamic Function ◽  
The Relationship

Цель исследования - изучение взаимосвязи между вариабельностью сердечного ритма (ВСР) системой гемостаза и гемодинамическими функциями у женщин больных эссенциальной гипертензией (ГБ) в зависимости от методов применяемой терапии. Методика. Под наблюдением находились 72 женщины, страдающие гипертонической болезнью. Обследовано 2 группы пациенток: 1-я группа (ГБ-1) находилась на медикаментозной терапии, 2-я (ГБ-2) - наряду с медикаментозной терапией регулярно на протяжении 2-3 лет проходила не менее 3 полуторамесячных курсов кинезитерапии. Для изучения гемодинамики был использован датчик динамического рассеяния света (miniature Dynamic Light Scattering - mDLS) от Elfi-Tech (Rehovot, Israel), измеряющий сигналы, инициированные кожным кровотоком и использующий методику разложения сигнала на частотные компоненты, связанные с разными гемодинамическими источниками. Из пульсовой компоненты mDLS сигнала извлекалась информация о вариабельности RR интервалов, и рассчитывались индикаторы вариабельности сердечного ритма. Изучали показатели свёртывающей системы крови: активированное парциальное тромбопластиновое время - (АПТВ), протромбиновое время (ПТВ) с вычислением МНО, тромбиновое время (ТВ), концентрация фибриногена, факторов II (протромбин), IIa (тромбин), IX и Х [10]. Кроме перечисленных методов исследования определялся пространственный рост фибринового сгустка, осуществляемый с помощью прибора «Регистратор Тромбодинамики Т-2». Достоинством способа является его объективность и то, что программой предусмотрена фоторегистрация роста сгустка через 5, 15 и 30 мин. Результаты. Как в группе ГБ-1, так и ГБ-2 выявлены многочисленные корреляционные связи между различными показателями ВСР, системы гемостаза и гемодинамических Данные представленные в виде матрицы свидетельствуют о том, что сдвиги в системе гемостаза и гемодинамики у больных ГБ-1, обусловленные деятельностью сердца и осуществляемые при участии как симпатического, так и парасимпатического отделов АНС способствуют возникновению тромботических осложнений. В то же время у больных ГБ-2 ВСР практически не коррелирует с показателями системы гемостаза и в меньшей степени связана с гемодинамические функции, благодаря чему состояние гемостаза и гемодинамики приближается к показателям здоровых женщин. Между тем, выявленные взаимосвязи между системой гемостаза и гемодинамическими функциями как у больных ГБ-1, так и ГБ-2 направлены на предотвращение внутрисосудистого свёртывания крови. Заключение. Применение систематической умеренной физической нагрузки на протяжении 2 - 3 лет способствует нормализации взаимоотношений между ВСР, системой гемостаза и гемодинамическими функциями у больных ГБ и способствует более устойчивой нормализации кровяного давления. Aim. To study the relationship between heart rate variability (HRV), hemostasis, and hemodynamic functions in women with essential hypertension (EH), depending on the method of therapy. Methods. 72 women with hypertension were monitored. Two patient groups were evaluated: the first group (EH-1) had recceived only drug therapy and the second group (EH-2), in addition to drug therapy, had regularly participated in at least three 1.5 mos long courses of kinesitherapy over a 2-3 years period. To study hemodynamics, we used a miniature Dynamic Light Scattering (mDLS) sensor from Elfi-Tech (Rehovot, Israel), which measures signals initiated by skin blood flow and uses a technique for decomposing the signal into frequency components associated with different hemodynamic sources. Information on the variability of RR intervals was extracted from the pulse component of the mDLS signal, and parameters of heart rate variability were calculated. Indexes of the coagulation system were studied, including activated partial thromboplastin time (APTT), prothrombin time (PTT) with calculation of INR, thrombin time (TT), concentrations of fibrinogen and factors II (prothrombin), IIa (thrombin), IX, and X [10]. In addition, spatial fibrin clot growth was determined with a Thrombodynamics Registrator T-2 apparatus. The method benefits are its objectivity and a possibility of photorecording of the clot growth at 5, 15 and 30 min. Results. Both in the EH-1 and EH-2 groups, numerous correlations were detected between various parameters of HRV, the hemostatic system, and hemodynamic functions, as well as between the parameters of the hemostatic system and hemodynamic functions. The data are presented in the form of a matrix. The data indicate that shifts in the hemostatic and hemodynamic systems of EH-1 patients induced by cardiac activity and resulting from activities of both the sympathetic and parasympathetic sections of the autonomic nervous system (ANS) are aimed at enhancing the hemostatic properties of blood, and this contributes to thrombotic complications. At the same time, in EH-2 patients, HRV had practically no effect on the hemostatic system and to a lesser extent was related with the hemodynamic function. Due to this, the state of hemostasis and hemodynamics in EH-2 patients approaches the state found in healthy women. In addition, the relationship between the hemostatic system and hemodynamic function in both EH-1 and EH-2 patients are aimed at preventing intravascular coagulation. Conclusion. The use of systematic, moderate physical activity for 2 to 3 years helps hypertensive patients to normalize the relationship between HRV, the hemostatic system, and hemodynamic functions. This contributes to a more normal and stable blood pressure.

Sugar-Sweetened Soft Drink Consumption Acutely Decreases Spontaneous Baroreflex Sensitivity and Heart Rate Variability

2021 ◽  
Author(s):  
Christopher L. Chapman ◽  
Emma L Reed ◽  
Morgan L Worley ◽  
Leonard D Pietrafesa ◽  
Paul J Kueck ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Baroreflex Sensitivity ◽  
Soft Drink ◽  
Soft Drinks ◽  
Paced Breathing ◽  
Soft Drink Consumption ◽  
Healthy Humans ◽  
Sequence Method

In healthy humans, fructose-sweetened water consumption increases blood pressure variability (BPV) and decreases spontaneous cardiovagal baroreflex sensitivity (cBRS) and heart rate variability (HRV). However, if consuming commercially available soft drinks containing high levels of fructose elicits similar responses is unknown. We hypothesized that high-fructose corn syrup (HFCS) sweetened soft drink consumption increases BPV and decreases cBRS and HRV to a greater extent compared to artificially-sweetened (Diet) and sucrose-sweetened (Sucrose) soft drinks and water. Twelve subjects completed four randomized, double-blinded trials in which they drank 500 mL of water or commercially available soft drinks matched for taste and caffeine content. We continuously measured beat-to-beat blood pressure (photoplethysmography) and R-R interval (ECG) before and 30 minutes after drink consumption during supine rest for 5 minutes during spontaneous and paced breathing. BPV was evaluated using standard deviation (SD), average real variability (ARV), and successive variation (SV) methods for systolic and diastolic blood pressure. cBRS was assessed using the sequence method. HRV was evaluated using the root mean square of successive differences in R-R interval (RMSSD). There were no differences between conditions in the magnitude of change from baseline in SD, ARV, and SV (P≥0.07). There were greater reductions in cBRS during spontaneous breathing in the HFCS (-3±5 ms/mmHg) and Sucrose (-3±5 ms/mmHg) trials compared to Water (+1±5 ms/mmHg, P<0.03). During paced breathing, HFCS evoked greater reductions in RMSSD compared to Water (-26±34 vs. +2±26 ms, P<0.01). These findings suggest that sugar-sweetened soft drink consumption alters cBRS and HRV but not BPV.

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

scholarly journals THE SUCCESS OF HEART RATE VARIABILITY BIOFEEDBACK PARAMETERS IN PERSONS WITH DIFFERENT LEVELS OF BLOOD PRESSURE

2013 ◽  
Vol 68 (7) ◽  
pp. 20-23
Author(s):  
L. V. Poskotinova ◽  
D. B. Demin ◽  
E. V. Krivonogova ◽  
M. N. Dieva ◽  
N. M. Khasanova
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Antihypertensive Drugs ◽  
Heart Rhythm ◽  
Total Power ◽  
Heart Rate Variability Biofeedback ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Objective. The aim was to determine the nature of cardiovascular reactions during a single session of heart rate variability (HRV) biofeedback in order to increase vagal effects on heart rhythm in patients with different initial levels of blood pressure (BP). Participants and methods. 33 people with normal blood pressure (group I), 20 people with uncorrected arterial hypertension (AH) grade 1-2 (group II) and 22 people with AH grade 1-2 taking antihypertensive drugs (group III) were observed. The parameters of heart rate variability (HRV), BP and pulse oximetry in the initial stage, during a single HRV biofeedback session and after this session in order to increase the total power of the HRV spectrum (each stage was 5 min). Results. In patients of group II low success of HRV biofeedback session, a high sympathetic reactivity and reduced oxygen blood saturation were determined. A reactivity of vagal mechanism is more pronounced in persons of group III than in those of group II. It is reflected in a significant increase in their total power of the HRV spectrum compared to the initial values and in uptrend saturation levels during the biofeedback session. Conclusions. The ability to HRV biofeedback in order to increase the total power of the HRV spectrum for standard short recording (5 min) can be seen as a test to determine the safety reserves of vagal autonomic cardiovascular regulation in persons with increased blood pressure. 

scholarly journals INFLUENCE OF THE TOTAL POWER OF THE HEART RATE VARIABILITY SPECTRUM ON THE SPECTRAL PARAMETERS DISTRIBUTION IN PATIENTS WITH ARTERIAL HYPERTENSION IN A PACED BREATHING TEST

2018 ◽  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Arterial Hypertension ◽  
Cardiac Activity ◽  
Heart Rhythm ◽  
Total Power ◽  
Spectral Parameters ◽  
Paced Breathing ◽  
Software Complex ◽  
Heart Rate Variability Spectrum

To determine the effect of the total power (TP) of the heart rate variability (HRV) spectrum on the distribution of high, low and very low frequency waves, 40 patients with arterial hypertension (AH) at the age of 58 ± 9 years were divided into 5 groups according to the degree of TP decrease in the initial stage of the test: 1st – more than 3000 ms2; 2nd – 3000–2000 ms2; 3rd – 2000-1000 ms2; 4th – 1000–500 ms2; 5th – less than 500 ms2. To assess HRV parameters in each group, 3 stages of the paced breathing test with a double (light and sound) metronome were evaluated; the hardware and software complex «Cardiolab» («HAI-Medica») was used. The distribution of the parameters was estimated taking into account the median, 25 and 75 quartiles. To estimate the differences between the statistical samples, the nonparametric Mann-Whitney U-test was used, as well as the Craskell–Wallis criterion. Statistically significant differences were considered between the data at a value of p < 0.05. It was found that the greater is the degree of TP reduction, the more significant is the autonomic imbalance, as well as the decrease in the influence of paced breathing on the regulation of the heart rhythm; at TP values below 1000 ms2 not only the parasympathetic component decrease is observed, but also the transition from sympathicotonia to the neurohumoral factors prevalence. In patients with arterial hypertension, there is a tendency of decrease in the total power of the HRV spectrum, thus reflecting the decreased functional capacity of heart rhythm regulation.The lower the degree of TP, the more significant is the disturbance of HRV regulation with a decrease in the parasympathetic component of the heart rate variability spectrum and the dominant influence of sympathetic and neurohumoral factors.The influence of the paced breathing on the heart rhythm regulation falls depending on the decrease in the total power of the HRV spectrum: at TP values below 1000 ms2 not only the parasympathetic component decrease is observed, but also the transition from sympathotonia to the neurohumoral factors prevalence.Decrease in TP can be considered as an indicator of aggravation of autonomic and neurohumoral regulation.Thepaced breathing test allows determine the basic level of cardiac activity regulation and dynamic disruptions in the distribution of HRV components in the metronomized breathing, as well as the possibilities for restoring the regulatory balance of heart rate variability, which is especially important in the examination of patients with arterial hypertension.

Effects of Isometric Biceps Exercise on Blood Pressure in Adults with Hypertension

2021 ◽  
Author(s):  
Paulo Henrique Medeiros Silva ◽  
Leandro Campos de Brito ◽  
Ludmila Lucena Pereira Cabral ◽  
Luiz Fernando Farias-Junior ◽  
Rodrigo Alberto Vieira Browne ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Effect ◽  
Exercise Session ◽  
Control Session ◽  
Acute Effects ◽  
Resting Blood Pressure

AbstractWe investigated the acute effects of isometric biceps exercise on resting and ambulatory blood pressure in hypertensive adults. A total of 12 medicated hypertensive adults (aged 47±7 years; body mass index 27.2±2.7 kg/m2; resting blood pressure 123±12/74±6 mmHg) performed an isometric biceps exercise session (bilateral biceps exercise; 4×1 min at 30% of 1-RM, 2 min recovery) and a control session (without exercise) in a randomized order separated by a 7 to 10-day period. Resting blood pressure, heart rate, and heart rate variability indexes (SDNN, RMSSD, LF, HF, and LF/HF) were measured pre- and up to 30 min post-sessions. Next, ambulatory blood pressure was monitored during 22-hour post-sessions (awake and asleep periods). No significant changes were observed for resting blood pressure, heart rate, or heart rate variability indexes up to 30 min post-sessions (p>0.05). Furthermore, no significant differences were observed in average ambulatory blood pressure values in 22-hour (126±11/71±6 mmHg vs. 126±15/71±9 mmHg), awake (127±10/74±6 mmHg vs. 130±14/75±10 mmHg), and asleep (123±15/68±6 mmHg vs. 120±17/66±9 mmHg) periods between the control and isometric sessions, respectively (p>0.05). In conclusion, an isometric biceps exercise session does not elicit an acute antihypertensive effect in adults with hypertension, which suggests that its prescription to improve the acute BP control is limited.

scholarly journals Effect of Losartan and Atenolol on heart rate variability in newly diagnosed essential hypertensive patient

2016 ◽  
Vol 6 (2) ◽  
pp. 161
Author(s):  
Shamima Sultana ◽  
Shelina Begum ◽  
Sultana Ferdousi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Essential Hypertension ◽  
Antihypertensive Drugs ◽  
Control Group ◽  
Newly Diagnosed ◽  
Hypertensive Patients ◽  
Group B ◽  
Mean Heart Rate

<p><strong>Background:</strong> Essential hypertension is associated with altered autonomic function. Essential hypertension is treated with drugs which modify the sympatho-parasympathetic balance. Losartan (angioteosin II receptor blocker) and atenolol (beta blocker) is commonly used antihypertensive drugs.</p><p><strong>Objective:</strong> To evaluate the effect of antihypertensive drugs on heart rate variability (HRV) in patients with essential hypertension.</p><p><strong>Methods:</strong> This prospective observational study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from July 2012 to June 2013 on 120 newly diagnosed hypertensive patients without any medication (group B, age 30-55 years). They were selected from the Out Patients Department (OPD) of cardiology, BSMMU, Dhaka. Age, sex and BMI matched 60 apparently healthy norrnotensive subjects were also studied as control (group A). Based on treatment, these study subjects were divided into two groups (BI and B2). Group B1<sub>a</sub> included 60 patients received Josartan 50 mg daily and B<sub>2a</sub> included 60 patients received atenolol 50mg daily. They were observed once before the treatment (B<sub>1a</sub> &amp; B<sub>2a</sub>), after 3 months medication (B<sub>1b</sub> &amp; B<sub>2b</sub>) and after 6 months medication (B<sub>1c</sub> &amp; B<sub>2c</sub>). For assessing HRV, Mean heart rate, Mean R-R interval, Max/Min R-R interval, SDNN, RMSSD were recorded by a polyrite. Data were compared among before treatment, after 3 months treatment and after 6 months treatment. For statistical analysis ANOVA, independent sample't' test and paired sample 't' test were performed. <strong></strong></p><p><strong>Results:</strong> Mean resting pulse rate, mean heart rate, systolic blood pressure, diastolic blood pressure were significantly higher and mean R-R interval, Max/Min R-R interval, SDNN, RMSSD were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normoten­sive subjects and after treatment. Jn both groups SDNN, RMS SD, mean R-R interval were found significantly higher after 6 months of treatment compared to their values after 3 months treatment. Again these values were found close to the values in normotensive subjects. In addition, mean heart rate was found significantly lower in atenolol treated patients than those of controls. Again in atenolol group these values were found significanLly higher than the corresponding values in losartan treated patients after 6 months treatment. <strong></strong></p><p><strong>Conclusion:</strong> Reduced cardiac vagal tone occurs in newly diagnosed hypertensive patients which is improved by both losartan and atenolol and in particular atenolol was found more effective.</p>

scholarly journals Choice of optimal antihypertensive therapy in patients with diabetes mellitus type 2

2022 ◽  
Vol 7 (4) ◽  
pp. 62-69
Author(s):  
V. A. Tsvetkov ◽  
E. S. Krutikov ◽  
S. I. Chistyakova
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Target Blood Pressure ◽  
Group I

Aim of the study: to develop personalized approaches to combined antihypertensive therapy in patients with type 2 diabetes mellitus and arterial hypertension, depending on the parameters of the daily blood pressure profile and heart rate variability.Material and methods. We examined 322 patients with type 2 diabetes and arterial hypertension who had not previously received antihypertensive drugs on a regular basis. At the first stage, patients were prescribed Perindopril 10 mg per day and Indapamide retard 1,5 mg per day. In the absence of reaching target blood pressure (BP) levels after 28 days, a third antihypertensive drug was added — Amlodipine 5 mg per day, followed by titration to 10 mg 1 r per day (group I) or a b-blocker — Carvedilol at a dose of 12,5 mg 2 r per day, also followed by titration up to 25 mg 2 r per day (group II). Daily monitoring of BP and ECG was carried out, the average daily heart rate (HR), circadian index (CI), as well as heart rate variability were determined.Results and its discussion. Patients with type 2 diabetes have a high variability of blood pressure throughout the day, high pulse blood pressure, as well as a rigid circadian profile of heart rate. The appointment of a standard two-component antihypertensive therapy, including Perindopril 10 mg and Indapamide retard 1,5 mg per day, allows reaching the target blood pressure only in 46% of patients. The addition of amlodipine or carvedilol significantly increases the effectiveness of therapy, allowing more than 80% of patients to achieve the target blood pressure. At the same time, the use of amlodipine leads to a greater extent to a decrease in pulse pressure, and the inclusion of carvedilol improves the circadian profile of blood pressure and heart rate, and has a positive effect on heart rate variability.

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