Analysis of lipid-lowering therapy in hypertensive patients

V.V. Batushkin


Arterial hypertension and lipid dysmetabolism are the key causes of unfavourable cardiovascular prognosis. Each of them provokes the development and progression of the diseases associated with atherosclerosis. A lot of patients have both of these factors. The article sounds the necessity of statins administration in hypertensive patients based on a case report. The paper deals with a clinical case of treatment of arterial hypertension in a 47-year-old patient with dyslipidemia at various stages with the further analysis of modern information on the combination of statins and antihypertensive agents sartans for the management of the patients with a high cardiovascular risk. After several years of effective antihypertensive therapy, the patient achieved target blood pressure parameters. He gave up smoking, improved his body mass. The patient presented with asymptomatic dyslipidemia not being controlled with any remedies. Asymptomatic non-occlusive atherosclerosis of the lower extremities was determined within the penultimate visit. Taking into account the signs of artery sclerosis, the patient is considered to be in a high-risk cardiovascular group. He needed intensive therapy with statins. This case requires the most effective and safe remedy and an adequate dose. The analysis of the clinical case of complex treatment of our patient with candesartan (Kantab) and atorvastatin (Tolevas) demonstrates two important factors provoked the peripheral artery disease development. First, a young man sought medical attention for arterial hypertension symptoms, which were the main for diagnosing and choosing the therapy. Concomitant dyslipi-demia was subclinical, and the patient discontinued the use of a medication by himself. A high level of cholesterol was a risk factor. Second, we kept up with the criteria of cardiovascular risk assessment in hypertensive patients (the Order of MH of Ukraine No 384 dated 24.05.2012), thus we did not insist on some stages of intensive statin therapy as the European and North American guidelines, 2017, recommend.


hypertension in middle-aged patient; subclinical atherosclerosis; features of treatment


Williams B., Mancia G., Spiering W. et al. 2018 ESC Guidelines for the management of arterial hypertension. European Heart Journal. 2018. 39. 3021-3104. URL: eurheartj/ehy339.

Whelton P.K., Carey R.M. The 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline for High Blood Pressure in Adults. JAMA Cardiology. JAMA Cardiology Clinical Guidelines Synopsis, February 21, 2018. URL:

Коваленко В.М., Корнацький В.М. Проблеми здоров’я і медичної допомоги та модель покращання в сучасних умовах: посібник для кардіологів, ревматологів, терапевтів, організаторів охорони здоров’я та лікарів загальної практики. Київ: Гордон, 2016. 261 с.

Abstract Book EuroPrevent 2017 Malaga, Spain. European Journal of Preventive Cardiology. 2017. Vol. 24. Issue 1. Suppl. URL:

Волков В.И., Исаева А.С. Эффективность терапии статинами у женщин. Ліки України. 2015. № 2. С. 4-9.

Батушкін В.В. Ефективність та безпечність статинів. Особливості вибору препарату. Кардиология: от науки к практике. 2018. 1(76). 68-81.

Heran B.S., Wong M.M., Heran I.K., Wright J.M. Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension. Cochrane Database Syst. Rev. 2008. 4. CD003822. [PubMed]

Smith D.H. Comparison of angiotensin II type 1 receptor antagonists in the treatment of essential hypertension. Drugs. 2008. 68. 1207-1225. [PubMed]

Csajka C., Buclin T., Brunner H.R., Biollaz J. Pharmacokinetic-pharmacodynamic profile of angiotensin II receptor antagonists. Clin. Pharmacokinet. 1997. 32. 1-29. [PubMed]

Van Liefde I., Vauquelin G. Sartan-AT1 receptor interactions: in vitro evidence for insurmountable antagonism and inverse agonism. Mol. Cell. Endocrinol. 2009. 302. 237-243. [PubMed]

Miura S., Karnik S.S., Saku K. Review: angiotensin II type 1 receptor blockers: class effects versus molecular effects. J. Renin Angiotensin Aldosterone Syst. 2011. 12. 1-7. [PMC free article] [PubMed]

Barra S., Vitagliano A., Cuomo V., Vitagliano G., Gaeta G. Vascular and metabolic effects of angiotensin II receptor blockers. Expert Opin. Pharmacother. 2009. 10. 173-189. [PubMed]

Shargorodsky M., Hass E., Boaz M., Gavish D., Zimlichman R. High dose treatment with angiotensin II receptor blocker in patients with hypertension: differential effect of tissue protection versus blood pressure lowering. Atherosclerosis. 2008. 197. 303-310.

Winkelmayer W.C., Zhang Z., Shahinfar S., Cooper M.E., Avorn J., Brenner B.M. Efficacy and safety of angiotensin II receptor blockade in elderly patients with diabetes. Diabetes Care. 2006. 29. 2210-2217. [PubMed]

Office of Disease Prevention and Health Promotion. Social determinants of health. 2016. URL: (accessed March 13, 2016).

Desai A.S., Swedberg K., McMurray J.J. et al. Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM Program. J. Am. Coll. Cardiol. 2007. 50. 1959-1966. [PubMed]

McMurray J.J., Ostergren J., Swedberg K. et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003. 362. 767-771. [PubMed]

Granger C.B., McMurray J.J., Yusuf S. et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003. 362. 772-776. [PubMed]

Yusuf S., Pfeffer M.A., Swedberg K. et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003. 362. 777-781. [PubMed]

Jackson E.A., El Khoudary S.R., Crawford S.L. Hot Flash Frequency and Blood Pressure: Data from the Study of Women’s Health Across the Nation. J. Womens Health. 2016. 25(12). 1204-1209.

Tamura Y., Kosuga M., Yamashita M. et al. Renoprotective effects of angiotensin II receptor blocker, candesartan cilexetil, in patients with stage 4–5 chronic kidney disease. Clin. Exp. Nephrol. 2008. 12. 256-263. [PubMed]

Rossing K., Christensen P.K., Hansen B.V., Carstensen B., Parving H.H. Optimal dose of candesartan for renoprotection in type 2 diabetic patients with nephropathy: a double-blind randomized cross-over study. Diabetes Care. 2003. 26. 150-155. [PubMed]

Féghali R.E., Nisse-Durgeat S., Asmar R. Effect of candesartan cilexetil on diabetic and non-diabetic hypertensive patients: meta-analysis of five randomized double-blind clinical trials. Vasc. Health Risk Manag. 2007. 3. 165-171. [PMC free article] [PubMed]

Ozaki N., Nomura Y., Sobajima H., Kondo K., Oiso Y. Comparison of the effects of three angiotensin II receptor type 1 blockers on metabolic parameters in hypertensive patients with type 2 diabetes mellitus. Eur. J. Intern. Med. 2010. 21. 236-239. [PubMed]

Knudsen S.T., Andersen N.H., Poulsen S.H. et al. Pulse pressure lowering effect of dual blockade with candesartan and lisinopril vs high-dose ACE inhibition in hypertensive type 2 diabetic subjects: a CALM II study post-hoc analysis. Am. J. Hypertens. 2008. 21. 172-176. [PubMed]

Philipp T., Martinez F., Geiger H. et al. Candesartan improves blood pressure control and reduces proteinuria in renal transplant recipients: results from SECRET. Nephrol. Dial. Transplant. 2010. 25. 967-976. [PubMed]

Grosso A.M., Bodalia P.N., Macallister R.J. et al. Comparative clinical- and cost-effectiveness of candesartan and losartan in the management of hypertension and heart failure: a systematic review, meta- and cost-utility analysis. Int. J. Clin. Pract. 2011. 65. 253-263. [PubMed]

Lithell H., Hansson L., Skoog I. et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J. Hypertens. 2003. 21. 875-886. [PubMed]

Schrader J., Lüders S., Kulschewski A. et al. The

ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke. 2003. 34. 1699-1703. [PubMed]

Sandset E.C., Bath P.M., Boysen G. et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet. 2011. 377. 741-750. [PubMed]

Chaturvedi N., Porta M., Klein R. et al. Effect of candesartan on prevention (DIRECT-Prevent 1) and progression

(DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials. Lancet. 2008. 372. 1394-1402. [PubMed]

Sjølie A.K., Klein R., Porta M. et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet. 2008. 372. 1385-1393. [PubMed]

Ogihara T., Nakao K., Fukui T. et al. Effects of cande-sartan compared with amlodipine in hypertensive patients with high cardiovascular risks: candesartan antihypertensive survival evaluation in Japan trial. Hypertension. 2008. 51. 393-398. [PubMed]

Nakao K., Hirata M., Oba K. et al. Role of diabetes and obesity in outcomes of the candesartan antihypertensive survival evaluation in Japan (CASE-J) trial. Hypertens. Res. 2010. 33. 600-606. [PubMed]

Tronvik E., Stovner L.J., Helde G., Sand T., Bovim G. Prophylactic treatment of migraine with an angiotension II receptor blocker: a randomized controlled trial. JAMA. 2003. 289. 65-69. [PubMed]

Yamashita T., Inoue H., Okumura K. et al. Randomized trial of angiotensin II-receptor blocker vs dihydropiridine calcium channel blocker in the treatment of paroxysmal atrial fibrillation with hypertension (J-RHYTHM II study) Europace. 2011. 13. 473-479. [PubMed]

Cuspidi C., Muiesan M.L., Valagussa L. et al.; CATCH investigators. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J. Hypertens. 2002. 20(11). 2293-2300.

Підлісна В.С., Верещук Л.Л., Качан О.В. Вплив тривалої терапії кандесартаном на показники кардіогемодинаміки у пацієнтів з артеріальною гіпертензією, ускладненою хронічною серцевою недостатністю. 17.10.2017. URL:іki -u-patcntv-z-arteralnoyu-gpertenzyu-u.

Сиренко Ю.Н., Донченко Н.В. Место кандесартана в современной терапии сердечно-сосудистых заболеваний: обзор доказательств. Артериальная гипертензия. 2011. 4(18). 114-126.

Campbell N.R., Gelfer M., Stergiou G.S. et al. A call to regulate manufacture and marketing of blood pressure devices and cuffs: a position statement from the World Hypertension League, International Society of Hypertension and Supporting Hypertension Organizations. J Clin. Hypertens. (Greenwich). 2016. 18. 378-80.

Cernes R., Mashavi M., Zimlichman R. Differential clinical profile of candesartan compared to other angiotensin receptor blockers. Vasc. Health Risk Manag. 2011. 7.


Copyright (c) 2019 HYPERTENSION

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта