Patologìâ (Dec 2018)
Сlinical and anamnestic features and their prognostic value in assessment of treatment effiiency of arterial hypertension with comorbidity
Abstract
Antihypertensive treatment leads to regression of left ventricular hypertrophy, reduces the incidence of cardiovascular complications and improves survival rates, and this occurs regardless of the degree of lowering of blood pressure (BP). The aim of the study was to determinate the prognostic significance of clinical and anamnestic factors in the evaluation of effectiveness of therapeutic correction of arterial hypertension (AH) associated with obesity and diabetes mellitus by angiotensin II receptors blocker, telmisartan. Material and methods. 135 patients were examined, diagnosed with AH stage I–II associated with obesity of 1–2 degrees (mean age 61.6 ± 6.7 years). Duration of study was 3 month. Chronic heart failure was no worse than II functional class by NYHA. Evaluation of prognostic properties of the studied factors was carried out using sequential hypothesis by Wald–Genkin, according to which all the indices were ranged with the subsequent determination of the prognostic coefficient (PC) and the general informativeness of the index (I). The groups were matched by sex, age, severity of the clinical condition, concomitant pathology. The control group consisted of 20 practically healthy persons of similar age and sex without signs of disease. Results. In the study, the predictive value of clinical and anamnestic parameters of the effectiveness of antihypertensive treatment was analyzed. The results show that some clinical and anamnesis factors of the disease can be used to determine the telmisartan effectiveness in the treatment of hypertension with obesity. The most informative criteria (I > 1.0) are the duration (more than 11 years) of arterial hypertension, as well as the age of the patient and the presence of concomitant pathology, in particular type 2 diabetes and obesity. Conclusions. Based on the obtained data about the value of clinical and anamnestic factors’ significance in assessing of the antihypertensive therapy in patients with co-morbid pathology, it is assumed that patients with hypertension duration of more than 11 years with concomitant obesity and type 2 diabetes and those older than 71 years require special tactics in the selection of antihypertensive therapy. And, most likely, such patients need more frequent adjustment of the doses of the drug.
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