Системные гипертензии (Dec 2016)
The effect of combined antihypertensive therapy on arterial wall rigidity in male patients with hypertension, obesity and obstructive sleep apnea
Abstract
Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.
