scholarly journals Treatment of arterial hypertension with diuretics depending on patient’s salt sensitivity

Author(s):  
Svitlana A. Yermolenko
2020 ◽  
Vol 27 (5) ◽  
pp. 60-73
Author(s):  
A. V. Fendrikova ◽  
V. V. Skibitskiy ◽  
E. S. Garkusha ◽  
A. I. Chesnikova ◽  
M. Е. Statsenko

Background. Effective drug therapy for resistant arterial hypertension is among major problems in modern medicine. The actual prevalence of resistant arterial hypertension is unknown, and its pathogenetic mechanisms are actively investigated. Among its important components is salt-sensitivity of the patient. At the same time, effi cacy of combined antihypertensive therapy in relation to salt-sensitivity of patients with resistant arterial hypertension is not fully understood.Objectives. Effi cacy assessment of personalised drug therapy in salt-sensitive and salt-resistant patients with resistant arterial hypertension.Мethods. We conducted a non-randomised controlled study with the observation time of 48 weeks. All patients had ambulatory blood pressure monitoring (ABPM) in the onset and past 48 weeks of treatment. Prior to therapy, the patient’s salt-sensitivity was determined with ABPM in salt loading (V.I. Kharchenko’s test). Two cohorts were formed with respect to the test results to include salt-sensitive (n = 67) and salt-resistant (n = 54) patients. Both cohorts received a combined therapy: enalapril 10 mg twice a day, amlodipine 10 mg/day, hydrochlorothiazide 12.5 mg/day, aliskiren 150 mg/day. If a target blood pressure was not observed in 3 weeks, aliskiren was elevated to 300 mg/day. Therapeutic effi cacy was assessed with ABPM after 48 weeks. Non-parametric statistical analysis was performed using Statistica 6.10 (StatSoftInc, USA).Results. The study included 121 patients with resistant arterial hypertension, median age 63 [58;67]. With background therapy, the target blood pressure was observed in 29 (43.4%) patients in cohort 1 and in 38 (70.4%) — in cohort 2 (intergroup p < 0.05). Statistically signifi cant lower ABPM values were registered in both cohorts after 48 weeks. Daily blood pressure normalised with therapy in 62.1% of patients in cohort 1 and in 68.4% — in cohort 2. The salt-resistant cohort exhibited a more pronounced reduction in ABPM values compared to salt-sensitive patients.Conclusion. Salt-sensitivity is a factor for personalising antihypertensive drug therapy in patients with resistant arterial hypertension due to specifi city of mechanisms for maintaining high blood pressure. Combined antihypertensive therapy with aliskiren is statistically more effective in salt-resistant than in salt-sensitive patients.


2021 ◽  
Vol 28 (2) ◽  
pp. 46-58
Author(s):  
V. V. Skibitskiy ◽  
V. Yu. Vasil’ev ◽  
A. V. Fendrikova

Background. An elevated or inadequate sensitivity to salt intake is an important mechanism for maintaining high blood pressure in patients with arterial hypertension. Chronopharmacotherapy comprises an important approach to control arterial hypertension through personalised correction of blood pressure but requires a further proof of efficacy in salt-sensitive hypertensive patients.Objectives. An assessment of six-month dynamics of diurnal and nocturnal peripheral and central blood pressure in salt-sensitive patients with arterial hypertension under chronopharmacothe­rapy.Methods. A controlled randomised trial included 86 salt-sensitive patients with arterial hypertension. Salt sensitivity was estimated with a Kharchenko’s test. All patients had circadian monitoring of the peripheral and central blood pressure and glomerular filtration rate at baseline and in a six-month follow-up. The patients were randomised into 3 cohorts. Cohort A united patients received perindopril and amlodipine in morning, cohort B — perindopril in morning, amlodipine in evening, cohort C — perindopril in evening, amlodipine in morning. Statistica 12 (StatSoftInc, USA) was used for nonparametric statistical analyses.Results. In six months of chronopharmacotherapy a target arterial pressure was registered in 87.5% patients in cohort A, 96.4 and 96.2% patients in cohorts B and C, respectively. All cohorts exhibited a declining peripheral and central blood pressure over therapy. Cohort A had a greater decline in daytime, and cohorts B and C — both diurnally and nocturnally. Cohorts B and C had more patients with an adequate nocturnal blood pressure decline. Glomerular filtration rate also elevated with perindopril or amlodipine intake before bedtime.Conclusion. The perindopril or amlodipine intake before bedtime in a combined therapy for arterial hypertension provided for a target blood pressure in the overall majority of patients, effectively reduced peripheral and central blood pressure at all time intervals, contributed to optimising the circadian blood pressure profile and increased the glomerular filtration rate.


2020 ◽  
Vol VIII(244) (30) ◽  
pp. 38-40
Author(s):  
S. A. Yermolenko ◽  
V. F. Orlovskyi ◽  
I. O. Moiseyenko ◽  
O. V. Orlovskyi

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