rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2012-8-5-661-666rpcardio-579Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINEОЦЕНКА ДИНАМИКИ СУТОЧНОГО ПРОФИЛЯ И ВАРИАБЕЛЬНОСТИ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ И АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ НА ФОНЕ ТЕРАПИИ ИВАБРАДИНОМСуровцеваМ. В.SurovtsevaM. V.

к.м.н., доцент кафедры внутренних болезней педиатрического и стоматологического факультетов

КозиоловаН. А.KoziolovaN. A.

д.м.н., профессор, заведующая кафедрой внутренних болезней педиатрического и стоматологического факультетов

nakoziolova@mail.ruЧернявинаА. И.ChernyavinaA. I.

ассистент кафедры внутренних болезней педиатрического и стоматологического факультетов

Пермская государственная медицинская академия им. академика Е.А. ВагнераРоссияPerm State Medical Academy named after academician E.A. WagnerRussian Federation20120601201685661666Copyright © Surovtseva M.V., Koziolova N.A., Chernyavina A.I., 20152015Суровцева М.В., Козиолова Н.А., Чернявина А.И.Surovtseva M.V., Koziolova N.A., Chernyavina A.I.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/579Aim

Aim. To assess the changes in blood pressure (BP) circadian profile and variability in patients with chronic heart failure (CHF) of ischemic etiology and arterial hypertension (HT) due to the complex therapy including ivabradine. Material and methods. Patients (n=90) with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM) was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively) as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively) and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016). More significant reduction in average daily and night systolic and diastolic BP (p=0.001), as well as daily and night BP variability (p=0.001) was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP) was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm.

 

 

Цель. Оценить динамику суточного профиля и вариабельности артериального давления (АД) у больных хронической сердечной недостаточностью (ХСН) ишемической этиологии и артериальной гипертензией (АГ) на фоне комплексной терапии с включением ивабрадина.  Материал и методы. Обследовано 90 больных ХСН II–III функционального класса (ФК) на фоне стабильной стенокардии II–III ФК и АГ . Пациенты рандомизированы на 3 группы: 1 группа — пациенты, получавшие периндоприл и ивабрадин; 2 группа — получавшие периндоприл, бисопролол и ивабрадин; 3 группа — пациенты, получавшие периндоприл и бисопролол. Длительность терапии составила 6 мес. Исходно и после лечения оценивали показатели суточного мониторирования АД (СМАД).  Результаты. В группах 1 и 2 в сравнении с 3 группой отмечено значимо более выраженное снижение среднесуточного САД (Δ%: -19,4±0,4; -21,1±0,4 и -11,8±0,6, соответственно) и ДАД (Δ%: -10,6±0,6; -12,9±0,4 и -4,3±0,3, соответственно), а также остальных показателей СМАД. Отмечено улучшение суточного ритма за счет увеличения количества больных в категории «Dipper» (p=0,016). В группе 2 в сравнении с группой 1 отмечено более выраженное снижение среднедневного и средненочного САД и ДАД (p=0,001), а так-же уменьшение вариабельности САД и ДАД в дневное и ночное время (p=0,001).  Заключение. При включении в комплексную терапию больных ХСН ишемической этиологии и АГ ивабрадина показан умеренный антигипертензивный эффект , как в отношении ДАД, так и САД, более выраженный при его комбинации с периндоприлом и бисопрололом. Это сопровождалось снижением повышенной вариабельности АД в течение суток и улучшением циркадного ритма АД.

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