rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2012-8-5-667-674rpcardio-580Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯEFFICACY OF COMBINED ANTIHYPERTENSIVE THERAPY IN ACHIEVEMENT OF TARGET BLOOD PRESSURE IN DIABETIC PATIENTSЭФФЕКТИВНОСТЬ КОМБИНИРОВАННОЙ АНТИГИПЕРТЕНЗИВНОЙ ТЕРАПИИ В ДОСТИЖЕНИИ ЦЕЛЕВОГО УРОВНЯ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМКошельскаяО. А.Koshel'skayaO. A.

д.м.н., профессор, в.н.с. отдела атеросклероза и хронической ИБС

koshel@cardio.tsu.ruЖуравлёваО. А.ZhuravlevaO. A.

н.с. отдела атеросклероза и хронической ИБС

КарповР. С.KarpovR. S.

д.м.н., профессор, академик РАМН, директор НИИ кардиологии СО РАМН, руководитель отдела атеросклероза и хронической ИБС НИИ кардиологии СО РАМН

Научно-исследовательский институт кардиологии Сибирского отделения Российской академии медицинских наукРоссияResearch Institute of Cardiology of the Siberian Branch of Russian Academy of Medical SciencesRussian Federation20120601201685667674Copyright © Koshel'skaya O.A., Zhuravleva O.A., Karpov R.S., 20152015Кошельская О.А., Журавлёва О.А., Карпов Р.С.Koshel'skaya O.A., Zhuravleva O.A., Karpov R.S.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/580

Aim. To evaluate the efficacy of long-term combined antihypertensive therapy (AHT) based on renin-angiotensin-aldosterone system (RAAS) blockers, indapamide and calcium channel blocker (CCB) in hypertensive patients with diabetes mellitus (DM) in accordance with target blood pressure (BP) <130/80 mm Hg achievement rate, dynamics of 24-hour BP profile, metabolic indices, and local stiffness of the main arteries. Besides, to study the effects of the CCB addition to dual therapy on these parameters. Material and methods. Patients (16 men, 31 women, 57.2±6.6 years old) with arterial hypertension degrees 1–3 and mild to moderate DM type 2 were included into the study. The patients were treated with perindopril (5–10 mg/day) or valsartan (80–160 mg/day) in combination with indapamide SR (1.5 mg/day) and amlodipine (5–10 mg/day). Examination included office BP measurement and ambulatory BP monitoring (ABPM), common carotid arteries sonarography , evaluation of serum levels of potassium, creatinine, uric acid, glucose metabolism and lipid profile parameters, calculation of insulin resistance index (HOMA) at baseline and after 30–32 weeks of treatment. Results. Target BP was achieved in 86.7% of patients. Evenly reduction of day and night BP without reflex tachycardia and hypotension episodes was observed. Office BP decreased from 149.5±12.0/90.0±8.3 to 125.0±7.6/76.8±4.9 mm Hg (p<0.05) and average daily BP (ABPM) decreased to 120.1±10.0/71.7±6.9 mmHg. Three drugs were needed to achieve target BP in baseline systolic BP >150 mm Hg (office) or >134 mmHg (ABPM). Marked beneficial effect on the morphological and functional characteristics of the vascular wall and its elastic properties, improvement of glycemic control, tissue insulin sensitivity and lipids profile were found. These effects were associated mainly with amlodipine inclusion into the therapy. Conclusion. The combined AHT based on RAAS blockers, indapamide SR and CCB provides achievement of target BP in the most of hypertensive patients with DM and accompanied by positive changes in vascular remodeling and metabolism.

Цель. Оценить у больных артериальной гипертонией (АГ), ассоциированной с сахарным диабетом (СД), эффективность длительной комбинированной антигипертензивной терапии (АГТ), основанной на блокаторах ренин-ангиотензин-альдостероновой системы (РААС), индапамиде и антагонисте кальция (АК), по достижению целевого уровня артериального давления (АД) <130/80 мм рт.ст., динамике показателей суточного профиля АД, метаболических показателей и локальной жесткости стенки магистральных артерий, а также установить, сопровождается ли добавление АК к двухкомпонентной АГТ дополнительными сдвигами данных параметров. Материал и методы. В исследование были включены 47 больных (16 мужчин, 31 женщина; 57,2±6,6 лет) АГ 1–3 степени в сочетании с СД 2 типа легкой или средней степени тяжести. Целевого АД достигали при использовании периндоприла аргинина (5–10 мг/сут) или валсартана (80–160 мг/сут) в комбинации с индапамидом SR (1,5 мг/сут) и амлодипином (5–10 мг/сут). Исходно и через 30–32 нед лечения пациентам проводилось обследование, включавшее офисное измерение АД и его амбулаторное суточное мониторирование (СМАД), ультразвуковое сканирование общих сонных артерий; определение сывороточного уровня калия, креатинина, мочевой кислоты, показателей углеводного обмена, состояние липидтранспортной функции крови, рассчитывали индекс инсулинорезистентности HOMA. Результаты. Целевое АД достигнуто у 86,7% больных, при этом отмечено равномерное в течение дневного и ночного периодов снижение среднесуточного АД без рефлекторной тахикардии и эпизодов гипотонии. Офисное АД снизилось с 149,5±12,0/90,0±8,3 до 125,0±7,6/76,8±4,9 мм рт.ст (р<0,05), по результатам СМАД среднесуточное АД снизилось до 120,1±10,0/71,7±6,9мм рт.ст. При исходном систолическом АД >150мм рт.ст. (офисное) или 134 мм рт.ст. (СМАД) для достижения целевого уровня АД требовалось три препарата. Отмечены благоприятные изменения морфо-функциональных показателей сосудистой стенки и ее эластических свойств, а также улучшение гликемического контроля, тканевой инсулиночувствительности и тенденция к возрастанию содержания антиатерогенной фракции холестерина, что реализовалось, главным образом, за счет включения в терапию амлодипина.  Заключение. Комбинированная АГТ , основанная на блокаторе РААС, индапамиде SR и АК, позволяет достичь целевой уровень АД у большинства пациентов с АГ и СД типа 2, что сопровождается положительной динамикой сосудистого ремоделирования и показателей метаболизма.

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