THE IMPACT OF COMBINATION ANTIHYPERTENSION THERAPY ON THE MAIN PARAMETERS OF STRUCTURAL AND FUNCTIONAL CONDITION OF MYOCARDIUM OF THE LEFT VENTRICLE AND THICKNESS OF “INTIMA-MEDIA” COMPLEX RELATED TO THE PHENOMENON OF SALT-SENSITIVITY IN PATIENTS WITH REFRACTORY ARTERIAL HYPERTENSION

Aim. To assess the influence of combination of antihypertension therapy on the main structure-function myocardium condition of the left ventricle (LV), thickness of intima-media (IMT) in patients with refractory arterial hypertension depending on the phenomenon of salt-sensitivity.

Material and methods. Totally, 192 patients included with RAH, that after assessment for salt-sensitivity were randomized to groups: 1st group — salt-sensitive patients, receiving inhibitor of angiotensin￾converting enzyme (ACEi), dihydropiridine calcium antagonist (DCA), thiazide diuretic (TD) and direct renin inhibitor (DRI) aliskiren (subgroup 1A) or β-adrenoblocker (β-AB) (subgroup 1B); 2 group — salt-resistant patients, receiving ACEi, DCA, TD and aliskiren (subgroup 2A) or β-AB (subgroup 2B). At the baseline and in 48 weeks of treatment the echocardiographic study was performed.

Results. Addition of DRI in 1A subgroup helped to reach target values of blood pressure (BP) in 43,3%, and in subgroup 2A — in 70,4% of patients. Usage of β-AB in subgroup 1B led to decrease of BP to target values in 54,3%, and in 2B subgroup — in 50% patients. Usage of DRI in salt-resistant patients helped significantly to regress the LV hypertrophy than in salt-sensitive. Increase of the number of persons with normalized geometry and diastolic function of the LV was comparable in both groups. Usage of β-AB in salt-sensitive and -resistant patients was followed by statistically more significant improvement of structural and functional condition of myocardium of the LV. Normalized geometry of the LV was registered significantly more commonly in slat-sensitive patients. The decrease of IMT was comparable at the background of the usage of both variants of therapy not depending from salt-sensitivity.

Conclusion. Usage of DRI as combination therapy led to more significant in salt-resistant than in salt-sensitive patients, antihypertensive effect and LV hypertrophy regress. Prescription of β-AB was followed by BP decrease to target values in comparable number of patients in 1B and 2B subgroups, but had some advantages in hypertrophy regression and normalization of LV myocardium geometry in salt-sensitive patients comparing to salt-resistant.

refractory arterial hypertension, salt-sensitivity, myocardium remodeling, aliskiren

1. Kobalava ZhD, Villevalde SV, Troitskaya ЕА. Consumption of salt and hypertension: is there any reason to change positions? Kardiologiia 2013; 11: 75-83. Russian (Кобалава Ж.Д., Виллевальде С.В., Троицкая Е.А. Потребление поваренной соли и артериальная гипертония: есть ли основания для смены позиций? Кардиология 2013; 11: 75-83).

2. Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clin Proc 2013; 88 (9): 987-95.

3. Aksyonov TA, Gorbunov VV. The role of endothelial dysfunction and taste sensitivity to salt in the development of left ventricular hypertrophy in hypertensive patients. Sibirskoe medicinskoe obozrenie 2013; 2: 27-30. Russian (Аксенова Т.А., Горбунов В.В. Роль дисфункции эндотелия и вкусовой чувствительности к поваренной соли в развитии гипертрофии левого желудочка у больных гипертонической болезнью. Сибирское медицинское обозрение 2013; 2: 27-30).

4. Diagnosis and treatment of hypertension. Russian guidelines (fourth revision). System Hypertension 2010; 3: 5-26. Russian (Диагностика и лечение артериальной гипертензии. Российские рекомендации (четвертый пересмотр). Системные гипертензии 2010; 3: 5-26).

5. Kharchenko VI, Luce VA, Rifai MA, et al. Salt, water stress and water-sodium metabolism in patients with essential hypertension. Terapevticheskii arkhiv 1984; 56 (12): 48-55. Russian (Харченко В.И., Люсов В.А., Рифаи М.А. и др. Солевые, водные нагрузки и водно-натриевый обмен у больных гипертонической болезнью. Терапевтический архив 1984; 56 (12): 48-55).

6. Gerdts E, Lund-Johansen P, Omvik P. Reproducibility of salt sensitivity testing using a dietary approach in essential hypertension. J Hum Hypertension 1999; 13: 375-84.

7. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31(10): 1925-38.

8. Pristrom MS, Sushinskiy VE. Diastolic dysfunction infarction: diagnosis and treatment approaches. Meditsinskie novosti 2008; 12: 17-9. Russian (Пристром М. С., Сушинский В.Э. Диастолическая дисфункция миокарда: диагностика и подходы к лечению. Медицинские новости 2008; 12: 17-9).

9. Babkin AP, Gladkikh VV, Kurbatov TL. Salt sensitive hypertension as a predictor of the effectiveness of antihypertensive therapy. International Medical J 2010; 3: 49. Russian (Бабкин А.П., Гладких В.В., Курбатова Т.Л. Солечувствительность артериальной гипертензии как предиктор эффективности антигипертензивной терапии. Международный медицинский журнал 2010; 3: 49).

10. Tseluyko VI. Aliskiren: A new group of drugs, new opportunities. Lіki Ukraіni 2009; 4: 66. Russian (Целуйко В.И. Алискирен: новая группа препаратов, новые возможности. Ліки Украіни 2009; 4: 66). 11. Danser AHJ, Deinum J. Renin, pro-renin and the putative (pro)renin receptor. Hypertension 2005; 46: 1069-76.

11. Alreja G, Joseph J. Renin and cardiovascular disease: Wornout path, or new direction? World J Cardiol 2011; 3(3): 72-83.

12. Campese VM, Karulan F. Saltsensitivity in hypertension: implication for the kidney. J Am Soc Nephrol 1991; 2: 53-61.

13. Babkin AP, Gladkikh VV. The role of the salt in the development of hypertension. International Medical J 2009; 3: 42. Russian (Бабкин А.П., Гладких В.В. Роль поваренной соли в развитии артериальной гипертонии. Международный медицинский журнал 2009; 3: 42).

14. Zhernakova JV, Chazova IE. The role of β-blockers in the treatment of hypertension: what we know today? System Hypertension 2015; 12 (1): 11. Russian (Жернакова Ю.В., Чазова И. Е. Роль β-адреноблокаторов в лечении артериальной гипертонии: что мы знаем сегодня? Системные гипертензии 2015; 12 (1): 11).