Acta Medica Leopoliensia (Dec 2016)
Clinical efficacy of losartan and ramipril in male patients with hypertension depending on age, uricemia level, and hypertension type
Abstract
Aim. Aging of population, treatment of cardiovascular diseases in the context of higher longevity, and improving the quality of life are considered among relevant problems of modern medicine. The purpose of our study was to evaluate clinical efficacy of Losartan and Ramipril in men with hypertension (HT), depending on their age, level of uricemia and HT type. Materials and Methods. We examined 90 elderly men of the average age of 72.5 years with Grade II hypertension. Most patients had high (54.4%) and very high (22.2%) cardiovascular risk. 69.5% of examined patients were senior males and 30.5% - elderly males. More than half (62.2%) of the patients were diagnosed with moderate AH (HT Grade II). 27.8% patients had severe AH (Grade III HT) and only 10.0% were mild (Grade I HT) cases. The largest portion (50.0%) were patients with a 10- to 20-year history of AH, and the smallest one (8.9%) - with over 20-year history of the disease. All patients were prescribed standard Losartan therapy or Ramipril in combination with Indapamidum, Amlodipinum and Doxazosin, if blood pressure control was needed. Apart from antihypertensive drugs, all patients were prescribed a daily dose of 75 mg acetylsalicylic acid and Rozuvastatinum at a dose of 10-20 mg per day. The dose of the latter was selected against the controlled value of LDL cholesterol with a target level <2.5 mmol/L. Follow-up lasted for 6 months. The therapy efficacy control was carried out using daily monitoring of blood pressure. A package of specialized program applications was used for the statistical analysis [8, 9]. Results and Discussions. As a result, administration of Ramipril, Indapamidum and Amlodipinum combination in the given group of patients demonstrated less antihypertensive efficacy compared with the group where Losartan, Indapamidum and Amlodipinum were administered (84.4% and 95.6%, accordingly). We used the Patient Impression Scale, which demonstrated almost equal tolerability of treatment in both Ramipril and Losartan groups (4.78 and 6.0 points, respectively). We also studied the efficacy of antihypertensive therapy in patients with hyperuricemia and isolated systolic hypertension. Conclusions. Six months of treatment revealed better antihypertensive efficacy of the Losartan + Indapamidum combination compared with the Ramipril + Indapamidum combination (62.2% and 46.7%, accordingly). Adding Amlodipinum to the regimen resulted in better antihypertensive efficacy of the combinations (95.6% to 84.4%, respectively). Ramipril was discontinued in 8.2% of patients and Amlodipinum - in 14.6% due to side effects. Ramipril appeared to deliver more antihypertensive efficacy in senior patients, whilst the effect of Losartan was independent of age. Hyperuricemia (HU) and isolated systolic hypertension (ISHT) resulted in lower antihypertensive efficacy of both Ramipril and Losartan.
