Cardiovascular risk, metabolic disturbances, and the choice of antihypertensive therapy
https://doi.org/10.15829/1728-8800-2011-4-26-32
Abstract
Aim. To study antihypertensive and metabolic effects of combined antihypertensive therapy with fixed doses of ACE inhibitor and thiazide-like diuretic (Noliprel®), in comparison with ACE inhibitor monotherapy (ramipril).
Material and methods. The study included 44 men, aged 30-65 years, with Stage I-II arterial hypertension (AH) and at least one manifestation of metabolic disturbances (dyslipidemia, pre-diabetes, or hyperuricemia). All participants were divided into two groups: Group I received ramipril, and Group II was administered a combination of ACE inhibitor and thiazide-like diuretic (Noliprel®/ forte).
Results. Medication doses were increased in patients who failed to achieve target blood pressure (BP) levels. At baseline and after 6 months of the treatment, all patients underwent BP and heart rate (HR) measurement, electrocardiography (ECG) at rest, and the assessment of lipid profile, fasting and post-load (2 hours) glucose, insulin resistance (IR) index, uric acid (UA) and potassium (К+), as well as total coronary risk level.
Conclusion. In men with AH and metabolic disturbances, combined antihypertensive therapy with fixed doses of ACE inhibitor and thiazide-like diuretic, as well as ACE inhibitor monotherapy, demonstrated good antihyperten-sive effectiveness and no deterioration in metabolic parameters. Combined antihypertensive therapy was associated with a reduction in coronary risk by 30 %.
About the Authors
M. N. Mamedov
State Research Centre for Preventive Medicine
Russian Federation
Moscow
Russian Federation
Moscow
M. V. Stroeva
State Research Centre for Preventive Medicine
Russian Federation
Moscow
Russian Federation
Moscow
R. T. Didigova
Ingush State University
Russian Federation
Nazran
Russian Federation
Nazran
E. A. Poddubskaya
State Research Centre for Preventive Medicine
Russian Federation
Moscow
Russian Federation
Moscow
M. N. Kovrigina
State Research Centre for Preventive Medicine
Russian Federation
Moscow
Russian Federation
Moscow
References
1. Оганов Р.Г. Концепция факторов риска как основа профилактики сердечно-сосудистых заболеваний. Врач 2001; 7: 3-6.
2. Шальнова С.А., Баланова Ю.А., Константинов В. В. и др. Артериальная гипертония: распространенность, осведомленность, прием антигипертензивных препаратов и эффективность лечения среди населения Российской Федерации. РКЖ 2006; 4: 45-50.
3. Преображенский Д.В., Сидоренко Б.А. Лечение артериальной гипертензии. Из-во Информатик. Москва 1999: 10-8.
4. Hansson L, Zanchetti A, Carruther S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) Randomized trial. Lancet 1998; 351: 1755-62.
5. Valensi P. All in one. Monde Moderne (France) 2004: p 71-110, 184-209.
6. Небиеридзе Д.В., Оганов Р.Г. Метаболические и сосудистые эффекты антигипертензивной терапии. Из-во Универсум Паблишинг. Москва 2005: 66-71.
7. Мамедов М.Н., Чепурина Н.А. Определение суммарного сердечно-сосудистого риска в клинической практике. Руководство для врачей. Москва 2008: 20-34.
8. DECODE Study Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999; 354: 617-21.
9. Мартынюк Т.В., Колос И.П., Чазова И.Е. Эффективность и безопасность фиксированной комбинации малых доз периндоприла/индапамида у пациентов с артериальной гипертонией в условиях реальной клинической практики (многоцентровое, открытое, проспективное исследование СТРАТЕГИЯ). Кардиоваск тер профил 2007; 6(8): 21-7.
10. Оганов Р.Г., Небиеридзе Д.В. Клиническая эффективность Нолипрела при лечении артериальной гипертонии. Основные результаты исследования ЭТАЛОН. Кардиология 2004; 44(3): 66-9.
11. HOPE study investigators Effects of an angiotensin-convertingenzime inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145-53.
12. ADVANCE trial study group Rationale, design of the ADVANCE study: a randomized trial of blood pressure lowering, intensive glucose control in high-risk individuals with type 2 diabetes mellitus. Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation. J Hypertens 2001; 19(Suppl): S21-8.
13. Рабочая группа по лечению артериальной гипертонии Европейского общества гипертонии (ESH) и Европейского общества кардиологов (ESC). Рекомендации 2007 года по лечению артериальной гипертонии. РФК 2008; 2: 93-123.
14. Berne C, Pollare T, Lithell H. Effects of antihypertensive treatment on insulin sensitivity with special reference to ACE inhibitors. Diabetes Care 1991; 14 (suppl 4): 39-47.
15. Gress TW, Nieto FJ, Shahar E, et al. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. New Engl J Med 2000; 342: 905-12.
Review
For citations:
Mamedov M.N., Stroeva M.V., Didigova R.T., Poddubskaya E.A., Kovrigina M.N. Cardiovascular risk, metabolic disturbances, and the choice of antihypertensive therapy. Cardiovascular Therapy and Prevention. 2011;10(4):26-32. (In Russ.) https://doi.org/10.15829/1728-8800-2011-4-26-32
Views:
532
Email this article 
