Perspectives of decreasing individual cardiovascular risk in high- and very high risk patients with arterial hypertension, treated with rilmenidine

Aim. To assess perspectives of decreasing individual cardiovascular event (CVE) risk and surrogate end-point incidence (blood pressure, BP; left ventricular hypertrophy, LVH; pulse wave velocity, PWV), in high- and very high-risk patients with Stage II-III arterial hypertension (AH), during 6-month rilmenidine monotherapy.
Material and methods. This open clinical trial included 20 high- and very high-risk patients (6 males and 14 females; mean age 63.2±10.4 years), with Stage II-II AH, who were administered rilmenidine, 2 mg/d, for 6 months. At baseline and in the end of the treatment phase, all participants underwent 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG), PWV measurement, biochemical examination, and individual CVE risk assessment by Framingham Scale. 
Results. After 6 months of rilmenidine monotherapy, target BP level was achieved in 78% of the patients. According to 24-hour BPM results, mean circadian systolic and diastolic blood pressure (SPB, DBP) levels had decreased by 10.5% and 7.4% (р<0.05), respectively. SBP and DBP morning surge rate had declined by 51.2% and 18.4% (p<0.05), respectively. For SBP and DBP, T/P coefficient was 76.0% and 63% (p<0.05), respectively. Rilmenidine therapy was associated with decrease in LV posterior wall thickness (from 10.2±0.2 to 9.8±0.1 mm), as well as carotid-femoral and carotid-radial PWV (by 21.7% and 20.1% (p<0.05), respectively). At baseline, total 10-year coronary heart disease (CHD) risk, calculated in Framingham model for SBP level, was 23.9% (standard risk 4.4%), for DBP level – 28.6% (standard risk 5.9%). After 6 months of rilmenidine monotherapy, the risk had decreased by 10.0% and 10.9% (p<0.05), respectively.
Conclusion. Rilmenidine possessed not only strong antihypertensive and organ-protective effects, but also decreased 10-year CHD risk in high- and very high-risk AH patients.

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