Modern Treatment of Hypertensive Patients in Present Economic Conditions: Focus on Effective Combinations of Domestic Production
Objective. It is known that the effectiveness of medications prescribed alone or as a combination is different. The objective of this study was to compare the effectiveness of therapy based on a combination of highly selective beta-blocker bisoprolol and hydrochlorothiazide (B + HCT) and an effective fixed combination of angiotensin-converting enzyme inhibitor lisinopril and hydrochlorothiazide (Lis + HCT) of domestic production.
Materials and Methods. The study included 59 patients with moderate to severe arterial hypertension (mean systolic (SBP)/diastolic blood pressure (DBP) — 171.3 ± 2.1/98.6 ± 1.3 mmHg). All patients at baseline and during follow-up underwent following procedures: measurements of weight and height, office SBP, DBP and heart rate (HR), ambulatory BP monitoring, determination of the pulse wave velocity in arteries of elastic (PWVe) and muscle (PWVm) types, central SBP (cSBP), biochemical blood tests, electrocardiography. Either a fixed combination Lis + HCT in a daily dose of 40 and 25 mg (n = 32), or a free combination of bisoprolol 10 mg and hydrochlorothiazide 25 mg (n = 27) were prescribed to the patients. If BP level after 1 month of treatment was higher than 140/90 mmHg, amlodipine 5 mg was added, its dose was increased to 10 mg if the therapy was insufficient on the 2nd month. In 3 months, if necessary, doxazosin 2–4 mg was added.
Results. There was the same significant decrease of office SBP/DBP in both Lis + HCT, and B + HCT groups (44.5 ± 1.9/19.0 ± 2.1 mmHg and 42.4 ± 2.1/18.8 ± 2.5 mmHg in each group, respectively, P was non-significant (NS) for difference between groups). The proportion of patients achieved target BP was 31.2, 53.1, 84.4 and 93.8 % in Lis + HCT group and 22.2, 48.1, 85.2 and 92.6 % in B + HCT group on the 1st, 2nd, 3rd and 6th months, respectively. 24SBP/24DBP decreased by 19.0 ± 3.3/19.3 ± 2.8 mmHg in Lis + HCT group and by 24.1 ± 1.8/16.9 ± 1.2 mmHg in B + HCT group, in addition, we observed a significant reduction in average daily HR in this group. Decrease of cSBP in Lis + HCT group was significantly higher than in group of bisoprolol-based combination (25.9 ± 2.9 mmHg vs 15.4 ± 2.9 mmHg, respectively; P < 0.05 for the degree difference of cSBP reduction between groups). In B + HCT group, a significant increase of augmentation index (from 19.7 ± 1.7 % to 24.6 ± 1.5 %; P < 0.05) was observed, in Lis + HCT group this index was not significantly changed. Significant dynamics of PWVe and PWVm wasn’t observed in any of the groups. In Lis + HCT group, PWVe decreased by 1.20 ± ± 0.08 m/s, in B + HCT group — by 0.63 ± 0.09 m/s, the difference between groups was significant (P < 0.001). There was a significant reduction in creatinine level on 6th month of treatment in Lis + HCT group (from 88.9 ± 3.7 µmol/l to 74.7 ± 3.8 µmol/l; P < 0.05), while in the group of bisoprolol combination this parameter decreased from 88.6 ± 3.2 µmol/l to 83.3 ± 2.5 µmol/l (P = NS).
Conclusions. Despite almost equivalent brahial BP decrease, according to both office measurement and the data of 24-hour monitoring, therapy based on combination of Lis + HCT had significantly better effect on cSBP reducing. Besides, only in this group we observed a significant decrease of serum creatinine concentration at the end of the study.
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