Experience with the Treatment of Patients with Arterial Hypertension and Concomitant Atrial Fibrillation Stented for Coronary Stenoses and Atherothombosis

N.M. Seredyuk, I.P. Vakaliuk, V.M. Yakymchuk, I.G. Kupnovytska, A.I. Volynskiy, R.V. Petrovskiy, L.V. Sorohtey

Abstract


Material and methods. This study included 1008 patients with arterial hypertension (AH) in combination with coronary artery disease (CAD) and atrial fibrillation (AF). All patients underwent selective coronary angiography, dynamic measurement of blood pressure (BP), recording an electrocardiogram, echocardiogram, coagulogram, lipid profile and other clinical and biochemical studies. Results. For the first time, it was found that comorbidity of AH, CAD and AF after coronary artery stenting for stable coronary heart disease creates additional difficulties in achieving target BP values and long-term maintenance of blood pressure in optimal-normal ranges. There has been shown the efficacy of a comprehensive treatment of patients with AH associated with CAD and AF using first-line antihypertensive drugs (angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists, diure­tics, β-blockers) and dual antithrombotic therapy (aspirin or clopidogrel or ticagrelor combined with rivaroxaban) provi­ding potentiation of antihypertensive and anti-ischemic effects ­using magnesium/potassium salt of pentahydroxyhexanoic acid (rhytmocor) and adenosine-containing drug advocard that can enhance the anti-ischemic effects of pharmacological precondititioning. Conclusions. The use of first-line antihypertensive agents in combination with rivaroxaban, rhytmocor and advocard increases anticoagulation and disaggregation potential of the blood, accelerates restoration of sinus rhythm in the presence of AF, prevents restenosis and stent thrombosis, eliminates the phenomena of slow flow and slow reflow in terms of coronary blood flow.


Keywords


arterial hypertension; coronary artery disease; atrial fibrillation; coronary stenting; first-line antihypertensive drugs; rivaroxaban; aspirin; clopidogrel; ticagrelor; rhytmocor; advocard

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DOI: https://doi.org/10.22141/2224-1485.6.50.2016.89770

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