CARDIOVASCULAR COMPLICATIONS RISK AND VASCULAR AGE DYNAMICS IN LONG-TERM TREATMENT OF ARTERIAL HYPERTENSION

Abstract

Aim. To evaluate the possibility for the novel scores implementation in everyday management by perindopril/amlodipine in arterial hypertension patients of high and very high risk.Material and methods. Totally, 30 patients included, with AH of high and very high risk (12 males, 18 females) at the age 57,7±9,3 y.o., who, after the in-patient management of non-controlled AH by fixed combination of perindopril/amlodipine doses 10/5, 5/10, 10/10 mg, respectively, were treated and followed up for the next 2 years (with additional control in 1 year). During this period there was control of BP dynamics, intervisit variability of SBP/DBP, adherence to treatment, some of hemodynamics values (by EchoCG), lipids, creatinin and glucose of blood. Based on the proposed new expert systems (ASCORE scale, “vascular age” assessment scale) a clinician evaluated the dynamics of individual risk of cardiovascular complications and the “vascular age”.Results. The outpatients had stage III AH, of those grade 2 AH was diagnosed in 26,7%, and grade3 in 73,3%. In one year of treatment by perindopril/amlodipine in office visit the level of SBP/DBP was 162,8±7,7/91,5±2,4 mmHg; adherence to treatment — 63,4%. During the second year patients adhered to clinicians recommendation, with the target BP levels achieved (adherence 83,4%). There was significant decrease of intervisit variability of SBP (with the baseline 11,6±1,4 mmHg at in-patient and to 4,3±0,2 mmHg in 2 years of outpatient treatment; p<0,001).Lipid spectrum values and glucose decreased significantly. Probability of 5-year risk of cardiovascular complications (CVC) decreased from 16,1±1,1% (in-patient) to 9,2±2,0% (p<0,01) and 4,4±0,7% (p<0,01) in 1 and 2 years, respectively. The “vascular age” during admittance was 14,4 years higher than real (passport), and in 2 years the values of passport age and VS overlapped (p<0,01).Conclusion. In real-practice circumstances we tested new European expert systems: 5-year risk score for cardiovascular events, and assessment of “vascular age” by SCORE, which demonstrated the probability of CVC risk decline and confirmed the concept of “vascular age” decrease under influence of effective antihypertension therapy. The fixed combination of perindopril/amlodipine, used during two years, showed clinical effectiveness in former non-controlled patients with AH, decreased the intervisit variability of BP, decreased individual risk of CVC and increased adherence to treatment.

Keywords

• perindopril/amlodipine
• cardiovascular complications
• vascular age