rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2019-15-3-305-314rpcardio-1950Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯEffect of the Single-Pill Amlodipine/Valsartan Combination on Hypertrophy and Myocardial Deformation Characteristics in Middle-Aged Patients with Essential Arterial HypertensionВлияние фиксированной комбинации амлодипин/валсартан на гипертрофию и деформационные характеристики миокарда у пациентов среднего возраста с эссенциальной артериальной гипертонией 1-2 степениКочетковА. И.KochetkovA. I.

к.м.н., н.с., лаборатория клинической фармакологии и фармакотерапии, Российский геронтологический научно-клинический центр, кафедра болезней старения,факультет дополнительного профессионального образования

Россия, 117997, Москва, ул. Островитянова, 1

MD, PhD, Researcher, Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center; Assistant, Chair of Aging Diseases

Ostrovitianova ul. 1, Moscow, 117997 Russia

БорисоваЕ. В.BorisovaE. V.

врач-кардиолог, первое кардиологическое отделение

Россия, 111399, Москва, Федеративный проспект, 17

MD, Cardiologist, Cardiology Department No1

Federativnii prospect, 17, Moscow, 111399 Russia

ОстроумоваО. Д.OstroumovaO. D.

д.м.н., профессор, зав. лабораторией клинической фармакологии и фармакотерапии, Российский геронтологический научно-клинический центр; профессор, кафедра клинической фармакологии и пропедевтики внутренних болезней

Россия, 117997, Москва, ул. Островитянова, 1

Россия, 119991, Москва, ул. Трубецкая, 8, стр. 2

MD, PhD, Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center; Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine

Ostrovitianova ul. 1, Moscow, 117997 Russia

Trubetskaya ul. 8-2, Moscow, 119991 Russia

ostroumova.olga@mail.ruЛопухинаМ. В.LopukhinaM. V.

к.м.н., зав. отделения функциональной диагностики

Россия, 111399, Москва, Федеративный проспект, 17

MD, PhD, Cardiologist, Head of Functional Diagnostics Department

Federativnii prospect, 17, Moscow, 111399 Russia

ПиксинаГ. Ф.PiksinaG. V.

к.м.н., зав. первого кардиологического отделения

Россия, 111399, Москва, Федеративный проспект, 17

MD, PhD, Cardiologist, Head of Cardiology Department No1

Federativnii prospect, 17, Moscow, 111399 Russia

Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, ОСП Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница им. Е.О. МухинаРоссияE.O. Mukhin Municipal Clinical HospitalRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова, ОСП Российский геронтологический научно-клинический центр Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияPirogov Russian National Research Medical University I.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation201901072019153305314Copyright © Kochetkov A.I., Borisova E.V., Ostroumova O.D., Lopukhina M.V., Piksina G.V., 20192019Кочетков А.И., Борисова Е.В., Остроумова О.Д., Лопухина М.В., Пиксина Г.Ф.Kochetkov A.I., Borisova E.V., Ostroumova O.D., Lopukhina M.V., Piksina G.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1950

Aim. To investigate the impact of amlodipine/valsartan single-pill combination (A/V SPC) on left ventricular hypertrophy (LVH) and left ventricular (LV) myocardial strain and stiffness parameters in naїve middle-aged patients with stage II grade 1-2 essential arterial hypertension (EAH).Material and methods. A group of patients with stage II grade 1-2 EAH who had not previously received regular antihypertensive treatment (AHT) [n=38; mean age 49.7±7.0 years] was retrospectively formed. All the patients were treated with A/V SPC and all of them achieved target office blood pressure (BP) (less than 140/90 mm Hg). And after 12 weeks follow-up (since the time of reaching the target BP) the AHT effectiveness assessment, its impact on LVH and LV myocardial strain and stiffness parameters (general clinical data, ambulatory blood pressure monitoring, conventional and 2D-speckle tracking echocardiography) were performed in all included patients.Results. The number of patients with LVH significantly (p=0.039) decreased from 25 individuals (65.8%) at baseline to 15 patients (39.5%) at the end of follow-up. Among patients with LVH at baseline after the treatment with A/V SPC significantly decreased (p<0.001 for all) interventricular septum thickness (from 1.36±0.19 to 1.28±0.18 cm), LV posterior wall thickness (from 1.08±0.09 to 0.97±0.11 cm) and the LV myocardial mass index (from 123.3±19.3 to 110.8±20.8 g/m2). At the end of follow-up end-systolic elastance significantly (p<0.001) decreased from 4.01±1.12 to 3.46±0.88 mm Hg/ml. In the subgroup of patients with reduced (in absolute value) LV longitudinal 2D-strain (n=27) at baseline, there was a significantly (p=0.005) increasing in this parameter at the end of the study (from -16.14±2.21% to -17.30±2.13%, Δ%=8.45±13.35).Conclusion. In naive patients 40-65 years old with stage II grade 1-2 EAH AHT with A/V SPC provides effective 24 hours BP control, significantly reduced LVH and improves LV strain parameters, which indicates decreasing of LV myocardial stiffness.

Цель. Изучить влияние фиксированной комбинации амлодипин/валсартан (ФК А/В) на выраженность гипертрофии миокарда (ГЛЖ) и деформационные характеристики миокарда левого желудочка (ЛЖ) у пациентов среднего возраста с эссенциальной артериальной гипертонией (АГ) II стадии 1-2 степени, не получавших ранее медикаментозной антигипертензивной терапии (АГТ).Материал и методы. Ретроспективно была сформирована группа пациентов с АГ II стадии 1-2 степени, ранее не получавших регулярную антигипертензивную терапию (n=38; возраст 49,7±7,0 лет), у которых на фоне терапии ФК А/В был достигнут целевой уровень артериального давления (АД) по рутинному измерению (менее 140/90 мм рт.ст.), и у которых через 12 нед после достижения целевого АД была проведена оценка эффективности АГТ и ее влияния на ГЛЖ и деформационные характеристики миокарда ЛЖ (общеклинические данные, суточное мониторирование АД, рутинная и 2D-Speckle Tracking трансторакальная эхокардиография).Результаты. Исходно ГЛЖ выявлена у 25 больных (65,8%), в конце периода наблюдения их количество статистически значимо (р=0,039) уменьшилось до 15 пациентов (39,5%). Среди пациентов с исходным наличием ГЛЖ на фоне терапии ФК А/В статистически значимо (p<0,001) снизились толщина межжелудочковой перегородки (с 1,36±0,19 до 1,28±0,18 см), толщина задней стенки ЛЖ (с 1,08±0,09 до 0,97±0,11 см) и индекс массы миокарда ЛЖ (с 123,3±19,3 до 110,8±20,8 г/м2). В конце периода наблюдения статистически значимо снизилась конечно-систолическая эластичность ЛЖ (с 4,01±1,12 до 3,46±0,88 мм рт.ст./мл; p<0,001). В подгруппе пациентов со сниженным исходно продольным 2D-стрейном ЛЖ (n=27) произошло статистически значимое (р=0,005) увеличение абсолютного значения данного показателя с -16,14±2,21%, до -17,30±2,13% (Δ%=8,45±13,35).Заключение. У нелеченных пациентов 40-65 лет с АГ II стадии 1-2 степени терапия ФК А/В обеспечивает эффективный контроль АД, снижает выраженность ГЛЖ и улучшает деформационные характеристики миокарда ЛЖ, что указывает на снижение его жесткости. 

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The authors declare that there are no conflicts of interest present.