Workplace arterial hypertension: potential of rilmenidine-based combination therapy

 Aim. To assess effectiveness and tolerability of morning / evening-administered rilmenidine in patients with work-place arterial hypertension (WpAH), during combination therapy. Material and methods. This randomized, short-term (8 weeks), pilot study included 20 males (mean age 48,5 years) with Stage I (n = 5) or Stage II (n = 15) AH, risk II (n = 4) or III (n = 16). Rilmenidine was administered in the morning (n = 10) or in the evening (n = 10). If needed, beta-adrenoblockers, ACE inhibitors, diuretics, nitrates, and digoxin were administered. The end-points included: blood pressure (BP) normalization - for mean daily ВР, according to 24-hour BP monitoring (BPM), and office BP (oBP); therapy response; circadian BP profile dynamics; temporary index (TI); circadian rhythm; quality of life (QoL); laboratory and instrumental parameters dynamics. Results. After 8 weeks of rilmenidine-based therapy, systolic oBP (SoBP) was normalized in 95% of the participants, diastolic oBP (DoBP) - in 100%. Mean daily DBP normalization, according to 24-hour BPM, was registered in all patients, and nighttime SBP response to treatment - in 90%. In the morning administration group, DBP was reduced by 22,1%, in the evening one - by 22,7%. For all time periods, pressure load on target organs substantially lowered. In the morning administration group, TI for daily SBP decreased by 53%, in the evening administration group - by 61,5%, TI for DBP - by 44,4% and 66,6%, respectively. Initially disturbed circadian rhythm normalized in 40% of the patients. The combination of rilmenidine with beta-blockers or ACE inhibitors was the most effective for BP reduction. Conclusion. Antihypertensive effect of rilmenidine-based therapy was combined with reduction in pressure load on target organs, as well as circadian BP rhythm improvement, and perfect tolerability

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