Vol 15, No 4 (2018)

Articles
Polypill" conception in modern cardiology
Chazova I.E., Aksenova A.V., Zhernakova Y.V.
Abstract
Combining treatments with antihypertensive, lipid lowering, antidiabetic and antiplatelet effects into a single pill significantly increases adherence to treatment, provides multiple control of risk factors and reduces the risk of cardiovascular diseases and fatal events. At the same time, there is still no convincing evidence that the using polypill in cardiology instead of the standard treatment strategy leads to a greater reduction in the incidence of primary end points (total mortality, fatal myocardial infarction, stroke, etc.)
Systemic Hypertension. 2018;15(4):6-7
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The role of b-blockers in the new revision of the 2018 European guidelines for the diagnosis and treatment of arterial hypertension in the patients with comorbidities
Ostroumova O.D., Kochetkov A.I.
Abstract
The review from the standpoint of the newest European guidelines for the diagnosis and treatment of arterial hypertension discusses the role of highly selective b-blockers and, above all, the superior member of these drugs - bisoprolol in blood pressure lowering therapy in comorbid patients with arterial hypertension. In terms of evidence-based medicine, the benefits of bisoprolol in patients with comorbid coronary heart disease, chronic heart failure, atrial fibrillation, and aortic pathology are discussed. The data on the feasibility and the possibility of including in the therapy highly selective b-adrenergic blockers in patients with chronic obstructive pulmonary disease, peripheral artery disease, diabetes and sexual dysfunction are presented
Systemic Hypertension. 2018;15(4):8-16
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Advantages of control over the course of hypertension disease with the fixed combination of amlodipine and perindoprilе arginin
Alyokhina O.D., Chesnokova I.V.
Abstract
Background. To improve the prognosis and quality of life of patients with essential hypertension, it is necessary to search for combinations of antihypertensive drugs that can affect all parameters of blood pressure (BP) and restrict remodeling of target organs. Aim. To study the effect of free and fixed combination of angiotensin converting enzyme inhibitor (perindopril arginine) and dihydropyridine calcium antagonist (amlodipine) on BP parameters, target organs damage criteria and quality of life of hypertensive patients. Materials and methods. The study included 92 patients suffering from arterial hypertension (AH) II and III stages. The 1st group included patients who received within 12 months treatment in a free combination of an angiotensin converting enzyme inhibitor (perindopril arginine) and amlodipine, in the 2nd group - in a fixed combination. The changes in BP indices were compared, including BP variability, criteria for target organs remodeling and quality of life assessed using the SF-36 questionnaire. Results. The results of office and 24-hour BP monitoring at the study stages demonstrated better control of all BP indices in patients of the 2nd group, reduction of short-, medium- and long-term BP variability. Against the background of treatment with a fixed combination of amlodipine and perindopril arginine, there were significantly more significant changes in 3 parameters of target organs remodeling: glomerular filtration rate, microalbuminuria, ankle-brachial index, and restoration of diastolic function of the left ventricle. At the same time, different positive dynamics of the quality of life indicators of patients of both study groups were noted. Conclusion. Fixed combined full-dose antihypertensive therapy with amlodipine and perindopril arginine allows achieving BP targets (including BP variability) in the majority of patients with AH II and III stages with high and very high risk of cardiovascular complications. High adherence to therapy allowed not only to maintain all parameters of blood pressure at the target level within a year, but also significantly improve the parameters of target organs remodeling and the quality of life of patients
Systemic Hypertension. 2018;15(4):17-23
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The relationship between the antihypertensive effect of b-adrenergic blockers and the initial daily variability of sinus rhythm
Sobolev A.V., Talabanov P.G., Ryabykina G.V., Kozhemyakina E.S.
Abstract
The objective of rhe study was to identify the features of the daily sinus rhythm variability (HRV), affecting the manifestations of the antihypertensive effect of b-adrenergic blockers and to establish the connection of this effect with the dynamics of the daily HRV. Material and methods. 52 patients with grade 1-2 degree essential arterial hypertension (32 to 60 years old - 21 men and 31 women) underwent general clinical and functional examination using bifunctional monitoring of ECG and blood pressure before and after treatment with carvedilol, nebivolol and bisoprolol. Monitor daily mean systolic (MSAD) and diastolic (MDAD) pressure were assessed in comparison with the distribution of heart rate during the day and the amount of HRV corresponding to different ranges of heart rate. Results. The initial average group values of the MSAD and MDAD parameters and the HR distribution during the day were equal in groups in groups with achieved (ABP) and not achieved (NABP) target blood pressure levels. Achievement of target levels of mean daily blood pressure (SBP≤130 mm Hg and DBP≤80 mm Hg) is associated with the initial quantitative parameters of daily HRV, corresponding to different ranges of HR. Differences between HRV in the ABP and NABP groups appear in the HR ranges of less than 75 beats/min: the initial values of HRV are greater in the ABP group than in the NABP group. In the range of heart rates 69-75 beats/min, the differences in HRV values become significant. As a result of therapy, the initially high mean group values of HRV in the ABP group decrease, while in the NABP group they remain unchanged. Conclusion. With initially high values of HRV in the heart rate range of 69-75 beats/min, the likelihood of a decrease in blood pressure to the target level during treatment with b-adrenergic blockers increases
Systemic Hypertension. 2018;15(4):24-29
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Modern combination antihypertensive pharmacotherapy
Mubarakshina O.A., Somova M.N., Batishcheva G.A.
Abstract
Achievement of target blood pressure levels is one of the main issues in antihypertensive pharmacotherapy. The article presents updated 2018 European Guidelines recommendations on target blood pressure levels in antihypertensive therapy and combined antihypertensive pharmacotherapy advantages. Modern fixed combinations including those with three active agents are discussed. A review of studies that show effectiveness and safety of long acting dihydropyridine calcium channel blocker amlodipine, thiazid-like diuretic indapamide, and angiotensin-converting enzyme inhibitor perindopril arginine fixed combination is presented
Systemic Hypertension. 2018;15(4):30-33
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Radiofrequency renal denervation with different device for treatment in patient with uncontrolled hypertension
Agaeva R.A., Danilov N.M., Shelkova G.V., Sagaydak O.V., Grigin V.A., Matchin U.G., Chazova I.E.
Abstract
Objective. To study the efficacy and safety of radiofrequency renal denervation with mono-electrode and multi-electrode devices in patients with uncontrolled arterial hypertension during follow-up period. Materials and methods. The study included 42 patients with uncontrolled arterial hypertension (mean age 51±12 years), while receiving multicomponent antihypertensive therapy, including diuretic. All patients underwent radiofrequency denervation of the renal arteries with a mono-electrode (n=27; group A) and multi-electrode devices (n=15; group B). The safety of the procedure was assessed using creatinine and glomerular filtration rate (MDRD equation), as well as according to ultrasound of the kidneys and renal arteries. The effectiveness of the procedure was study according to office blood pressure (BP) and ambulatory BP monitoring (ABPM). Results. In the general group, according to office BP after 6 months, there decreased in systolic (SBP)/diastolic BP (DBP) by 28/13 mm Hg (p=0.000001). According to ABPM, there was a decrease in the average daily SBP by 9 mm Hg (p=0.007) and DBP by 6 mm Hg (p=0.03). No significant changes in creatinine and glomerular filtration rate were detected in the general group. According to ABPM, after 6 months in group B, there was a decrease in the average daily SBP/DBP by 13 and 6 mm Hg (p=0.1). In group A, according to the ABPM, after 6 months, there was a decrease in the average daily SBP and DBP by 7 mm Hg (p=0.001) and 4 mm Hg (p=0.03). After 1 year, according to the office BP, there was a decrease in SBP/DBP by 14/11 mm Hg (p=0.002), and after 3 years at 15/17 mm Hg (p=0.3). Conclusion. The results confirm the safety and efficacy of radiofrequency renal denervation. Renal denervation in combination with drug therapy leads to decreasing of BP after 6 months and in the long-term
Systemic Hypertension. 2018;15(4):34-38
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Features of antihypertensive and vasoprotective efficiency of combination of valsartan and amlodipine in patients with obesity under different polymorphic variants of CYP2C9 and CYP11B2 genes
Kovalenko F.A., Skibitsky V.V., Fendrikova A.V.
Abstract
Purpose. To evaluate the efficiency of combination antihypertensive therapy with valsartan and amlodipine in patients with arterial hypertension (AH) and obesity, depending on the polymorphisms of the CYP2C9 and CYP11B2 genes. Materials and methods. In research included 80 obese patients (body mass index ≥30 kg/m2) and AH 1-2 disease blood pressure (BP) ≥140/90 mm Hg and <180/110 mm Hg against the background of previous antihypertensive therapy) uncontrolled medication. The patients included in the research received a fixed combination of valsartan and amlodipine at doses of 80-160/5-10 mg/day. All patients were measured office BP, implementambulatory blood pressure monitoring (ABPM) with the definition of central aortic systolic pressure (CASP) and stiffness indicators vascular wall at baseline and after 16 weeks of therapy. Venous blood samples were taken from all patients, followed by DNA extraction from leukocytes by the method of phenol-chloroform extraction. Determination of polymorphic variants of the researched genes was performed by amplification in real time on the amplifier Rotor Gene Q. We used sets of primers and probes (“Sintol”, Russia) and the Taq Man method (allele discrimination). Results. It was shown that patients with *1/*2 and *1/*3 variants more often reached the target level of office BP than with polymorphism *1/*1 (respectively 92.8 and 90.1% vs 43.7% cases, p<0.05). At the same time, in patients with polymorphisms *1/*2 and *1/*3 compared with persons who had the option *1/*1, a more expressed decrease in most indicators of ABPM and positive changes in the CASP and stiffness of the vascular wall (p<0.05) were found. When analyzing the effeciency of treatment with regard to polymorphic variants of the CYP11B2 gene, significantly more frequent achievement of the target level of BP was observed with mutant polymorphism *2/*2, than with polymorphism *1/*2 (76.5% vs 50%). When comparing the degree of change in ABPM, CASP, and vascular wall stiffness, depending on the polymorphic variant of the CYP11B2 gene, a more pronounced positive dynamics of most parameters in polymorphism carriers *2/*2 was found than in persons with *1/*1 and *1/*2. It was also found that among persons with the most frequent polymorphism of the CYP2C9 gene - *1/*1, reached the target level of BP as a result of 16-week therapy, there was a significant predominance of the polymorphism *2/*2 of the CYP11B2 gene over its other variants. Conclusion. Obtained during our study data on the relationship of the effectiveness of therapy with valsartan and amlodipine with different polymorphisms of the CYP2C9 and CYP11B2 genes can be used and taken in to account in the individualized selection of antihypertensive therapy patients with AH and concomitant obesity. It can also be assumed that genetic testing preceding the correction of treatment, as one of its personalization options, will help increase the effectiveness of pharmacotherapy in patients with AH and obesity
Systemic Hypertension. 2018;15(4):40-46
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Organoprotection with arterial hypertension 2-3 degrees
Afonicheva I.I., Melnik M.V., Knyazeva S.A., Kazyulin A.A.
Abstract
Objective. Arterial hypertension (AH) is one of the most common and socially significant diseases worldwide. Despite years of experience gained in studying hypertension, the problems concerning selection of antihypertensive therapy with pleiotropic organ-protecting effects are still of current importance. Purpose - to assess therapeutic efficacy and pleiotropic organ-protective capability of third-generation calcium antagonist lercanidipine in patients with stage 2-3 hypertension. Materials and methods. Our study enrolled a total of ninety-two 31-to-84-year-old patients. Of these, 72 patients diagnosed as having stage 2 or 3 AH composed the Study Group and 20 apparently healthy subjects were included into the Control Group. At baseline and after 6 months, all patients of the Study Group underwent examinations consisting in measuring biochemical parameters [total cholesterol (TCH), triglycerides, low-density lipoprotein cholesterol (LDL CH), uric acid, urea, creatinine, glucose], 24-hour ambulatory BP monitoring, echocardiography in order to assess the dimensions and volume of the cardiac chambers, thickness of the left ventricular posterior wall (LVPW) and left-ventricular myocardium mass index (LVMMI), studying microalbuminuria (MAU), a known marker of endothelial dysfunction and early renal lesion; assessing the state of the vascular wall by the ankle-brachial index (ABI) and pulse pressure (PP). Antihypertensive therapy consisted in lercanidipine alone taken at a dose of 10-20 mg/day, failure to thereby achieve the target BP level was followed by additionally prescribing an angiotensin converting enzyme (ACE) inhibitor, enalapril, given at a dose of 5-20 mg twice daily. Results. All patients by the end of the study achieved the target level of AP (p≤0.05), also demonstrating significantly improved (p≤0.01) parameters of endothelial dysfunction and an early marker of renal damage (MAU), indices of elastic properties of the vascular wall ABI (p≤0.05) and PP (p=0.01). Significantly positive dynamics was observed for the following parameters: decreased creatinine concentration (p≤0.001), increased GFR (p≤0.001), decreased levels of TCH (p≤0.01) and LDL CH (p≤0.001). Conclusion. Lercanidipine therapy of patients with stage 2-3 AH proved highly efficient, well tolerated, metabolically neutral with pleiotropic organprotecting properties in the form of improved condition of the vascular wall, correction of endothelial dysfunction, nephroprotective action
Systemic Hypertension. 2018;15(4):47-52
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Evaluation of effectiveness and safety of the first Russian-manufactured generic bosentan use in patients with pulmonary arterial hypertension
Arkhipova O.A., Gratsianskaya S.E., Martynyuk T.V.
Abstract
Objective. To study effectiveness and safety of generic bosentan use for 24 weeks in patients with pulmonary arterial hypertension (PAH). Materials and methods. The study included 42 patients. In 22 patients Bosentan therapy (Bosenex®, Sotex, Russia) was used for the first time. In 20 patients switching therapy from original bosentan (Tracleer, Аctelion Pharmaceuticals Ltd., Switzerland) was performed. The patients were followed up for 24±2 weeks. Results. After 24 weeks of treatment percent of patients with functional class (FC) III decreased from 55 to 30%, percent of patients with FC II increased from 45 to 55%, some patients (15%) achieved FC I, and the 6-minute walk distance increased on 52.1 meters. In the group of therapy change heart failure FC stabilization was observed, 6-minute walk distance increased on +14.8 meters (р>0.05). Echocardiography in the first group showed significant decrease of pulmonary artery systolic pressure (PASP) at -4 mm Hg and of right atrium area on 0.9 cm2. In the switched therapy group the difference was not significant. According to chest X-ray examination change of cardio-thoracic ratio, Murray and Lupi indexes was not significant in both groups. According to results of right heart catheterization improvement of mean pulmonary arterial pressure (-6.7 mm Hg), mean right atrial pressure (-1.6 mm Hg with reference value reached), and pulmonary vascular resistance (-293.2 dynes×sec/cm-5) was achieved; р<0.05. Bosenex therapy was tolerated well and development of clinically significant adverse effects was not observed. Conclusion. Use of first generic bosentan for 24 weeks resulted in improvement of clinical and haemodynamic parameters as well as in improvement of functional ability of patients with PAH of II-III FC (World Health Organization). Switching from original medication to Bosenex® was not followed by patients’ clinical status impairment or with adverse effects development. Patients who used Bosenex® developed only adverse effects that typically occur in this medications class use, the frequency of adverse effects development did not exceed the claimed one
Systemic Hypertension. 2018;15(4):53-58
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Evaluation of subclinical cardiotoxicity in patients with breast cancer and arterial hypertension in two regimens of anthracycline-containing chemotherapy
Avalyan A.A., Oshchepkova E.V., Saidova M.A., Shitov V.N., Glazkova E.V., Stenina M.B., Chazova I.E.
Abstract
Objective. To study of subclinical cardiotoxicity of two anthracycline-containing chemotherapy regimens in breast cancer patients with normotension and arterial hypertension. Materials and methods. 119 women (mean age 48,8±10,9 years) with triple negative breast cancer were enrolled. They are received one of two chemotherapy options that differed in the intensity and duration of treatment, including the total dose of anthracyclines. Depending on the chemotherapy option, the patients were divided into two groups: group 1 (n=54) - treatment duration ≤8 weeks, cumulative dose of doxorubicin was 200 mg/m2, group 2 (n=65) - treatment duration ≤16 weeks, the cumulative dose of doxorubicin was 320 mg/m2. Before and after chemotherapy completion of all patients, the level of troponin T (h.s.) and NT-proBNP was determined, and heart ultrasound was performed, 2D and 3D speckle tracking imaging. Results. In patients who received a higher cumulative dose of doxorubicin (group 2), a statistically significant increase in biomarkers of myocardial damage was observed (h.s. troponin T before chemotherapy was 7.8±0.5 pg/ml, after chemotherapy - 55.0±7.0 pg/ml, p<0.05; NT-proBNP before chemotherapy was 88.6±10.7 pg/ml, after chemotherapy - 359.2±57.9 pg/ml, p<0.05) and a decrease in GLS according 2D speckle tracking imaging (from -20.4±0,4 to -16.8±0.4%, p<0.05) and GLS according 3D speckle tracking imaging (from -11.6±0.5 to -7.8±0.5%, p<0.05 ) and GAS according 3D speckle tracking imaging mode data (from -19.7±0.7 to -14.5±0.8%, p<0.05). The most pronounced changes were observed in patients with arterial hypertension. Conclusions. Increased risk of subclinical cardiotoxicity was associated with a higher cumulative dose of doxorubicin (320 mg/m2), as well as in patients with breast cancer with arterial hypertension
Systemic Hypertension. 2018;15(4):59-64
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Epicardial fat: a new cardiometabolic risk marker, a new therapeutic goal in obese patients
Blinova N.V., Zhernakova Y.V., Azimova M.O., Azimova M.R., Chazova I.E.
Abstract
Epicardial fat (EF) is thought to be a cardiovascular risk factor, it has attracted a great interest from researchers and is relevant to study. The article presents a review on EF influence on cardiovascular system and metabolic parameters, as well as new therapeutic approaches to modify EF volume. There are no established methods for EF parameters measurement at present. The use of transthoracic echocardiography which is a simple, accessible, and informative procedure is suggested as one of these methods
Systemic Hypertension. 2018;15(4):66-69
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Abdominal visceral adipose tissue ultrasound assessmet as a tool in predicting of high cardiometric risk obesity
Druzhilov M.A., Druzhilova O.Y., Kuznetsova T.Y.
Abstract
Objective: to conduct the analysis of association abdominal visceral adipose tissue ultrasound indices with parameters of cardiovascular remodeling and metabolic risk factors with subsequent evaluation of their use as a predictor of high cardiometabolic risk obesity. Material and methods. Totally, 274 normotensive males investigated (mean age 44.8±5.0 y. o.), with no clinical signs of cardiovascular disorders and type 2 diabetes, with the SCORE risk <5% and abdominal obesity. The assessment included the analysis of metabolic risk factors, ultrasound assessment of abdominal adipose tissue thickness and its ratio to subcutaneous fat thickness, echocardiography, brachiocephalic arteries triplex scanning, bifunctional 24-hour blood pressure monitoring. Results. The association revealed, of the abdominal visceral adipose tissue ultrasound indices with metabolic risk factors and parameters of cardiovascular remodeling, more strong compared with the waist circumference. Patients with the ratio of the ultrasonic abdominal visceral adipose tissue thickness to subcutaneous fat thickness ≥3.0 (n=77) were different (comparing to the group in general) by higher rate of hypertrophy existence (31.2% vs 11.7%, p<0.001) and diastolic dysfunction of the left ventricle (40.3% vs 16.8%, p<0.001), hypertrophy of the intima-media of carotid artery (49.4% vs 29.2%, p<0.001), carotid atherosclerosis (46.8% vs 18.2%, p<0.001), prediabetes (39.0% vs 16.1%, p<0.01), high grades albuminuria (24.7% vs 9.1%, р<0.001). An equation predictive estimates of the ratio of the ultrasonic abdominal visceral adipose tissue thickness to subcutaneous fat thickness: waist circumference × 0.006 + fusting blood glucose × 0.192 + total cholesterol × 0.115 + uric acid × 1.187. Conclusions. In asymptomatic for CVD patients the presence of visceral obesity, verified on the ultrasound indices of abdominal visceral adipose tissue assessment, indicates a high probability of metabolic disorders and subclinical organ disorders. The ratio of the ultrasonic abdominal visceral adipose tissue thickness to subcutaneous fat thickness can act as an index of visceral obesity, whose value ≥3.0 allows us to speak about the most likely high cardiometabolic risk
Systemic Hypertension. 2018;15(4):70-75
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Communication of subcutaneous, visceral, periaortic, epicardial fat and metabolic parameters with arterial stiffness in young people with abdominal obesity
Zheleznova E.A., Zhernakova Y.V., Chazova I.E., Rogoza A.N., Zairova A.R., Shariya M.A., Yarovaya E.B., Orlovsky A.A., Blinova N.V., Azimova M.O., Gorieva S.B., Konosova I.D.
Abstract
Obesity plays a key role in the epidemic of type 2 diabetes mellitus (DM), cardiovascular and cerebrovascular diseases. Most studies confirm the association of increased arterial stiffness with obesity. However, the interrelation of various fat depots with one of the main indicators of vascular wall stiffness - the cardiovascular vascular index (CAVI) is currently not clear. The purpose of this study is to assess arterial stiffness in people with abdominal obesity without metabolic syndrome (MS) and with MS, the connection of fat depots (visceral, subcutaneous, perivascular, epicardial fat) with the stiffness parameter CAVI. Materials and methods. 68 people with abdominal obesity (AO) at the age of 18-45 years. The study included height, weight, BMI, waist circumference, and biochemical blood tests (fast glucose and glucose tolerance, uric acid, creatinine, GFR - MDRD, lipid profile, insulin, HOMA-IR). 24-hour blood pressure monitoring, computed tomography (Aquilion One Vision Edition, Toshiba, Japan) with the definition of subcutaneous, visceral, perivascular, epicardial fat, and also calculated the ratio subcutaneous to visceral fat. It was determined CAVI on the VaSera 1000 unit (Fukuda Denshi, Japan) to assess arterial stiffness. Abdominal obesity was derteming by cut off waist circumference >80 cm for women and >94 cm for men. As a result, we were formed 2 groups: persons with abdominal obesity and the presence of no more than one additional risk factor (metabolically healthy) - group 1, persons with MS (abdominal obesity in combination with 2 and more extra risk factors) - group 2, the control group consisted of healthy individuals (n=15) without obesity - group 0. Results. There was no statistically significant difference between CAVI groups. Correlations of CAVI with age r=0.340 (p=0.005), with daytime mean systolic blood pressure - SBPm average (r=0.280, p=0.021) and with mean diastolic blood pressure - DBPm average (r=0.329, p=0.006), with night SBPm average (r=0.233, p=0.014) and with DBPm average (r=0.297, p=0.014), with the volume of periaortic fat (r=0.218, p=0.074) were found. An inverse correlation was found between CAVI and BMI (r=-0.279, p=0.021), with subcutaneous fat depot (r=-0.285, p=0.019) and with the ratio of subcutaneous to visceral fat (r=-0.303, p=0.012). According to the multivariate regression analysis, the most significant impact on CAVI is exerted by age, daytime SBPm, BMI, and the volume of periaortic fat
Systemic Hypertension. 2018;15(4):76-82
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Chronic myocardial damage in idiopathic pulmonary arterial hypertension: a clinical case
Bykov A.N., Arkhipov M.V., Klimusheva N.F., Iofin A.I., Krokhalev V.Y.
Abstract
Chronic myocardial injury, determined by a constantly elevated cardiac troponin (cTn) value, may occur in patients with pulmonary arterial hypertension (PAH), indicating the severity of the disease and associated with an adverse prognosis. Increasing of cTn among patients with PAH was registered prior to 2018, but after the Fourth universal definition of myocardial infarction (2018) was released the understanding of this phenomenon has been changed. One of the causes of chronic myocardial injury in patients with PAH is the compression of coronary arteries. Left main coronary artery (LMCA) compression is an uncommon and probably underestimated cause for angina-like chest pain and ventricular dysfunction in patients with severe pulmonary artery hypertension. LMCA compression by an enlarged pulmonary artery trunk has been associated with angina, but appropriate diagnostic and treatment approaches remain poorly defined. This is a case report on a woman with idiopathic PAH and compression of the LMCA by an enlarged pulmonary artery. The diagnosis of LMCA stenosis was confirmed by multi-slice computed tomography and coronary angiography. Biomarkers such as cTn and brain natriuretic peptide have also been identified as criteria of optimal treatment. Percutaneous coronary intervention in conjunction with PAH-specific therapy appears to be a feasible, safe, and effective treatment option for patients with extrinsic compression of the LMCA from pulmonary artery enlargement
Systemic Hypertension. 2018;15(4):83-90
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Combined antihypertensive therapy in the light of modern recommendations: strategy of one tablet
Morozova T.E.
Abstract
The review focuses on the main strategies of antihypertensive therapy set out in the 2018 ESC/ESH recommendations. The basis of antihypertensive therapy consists of five main classes of antihypertensive drugs, which should form the basis of the combined drug antihypertensive therapy in most patients. The single pill strategy is to take advantage of fixed combinations as a starting antihypertensive therapy for most patients. Among the fixed combinations, the combination of an ACE inhibitor with a diuretic (Noliprel®) remains one of the most preferred for antihypertensive therapy, since In addition to its antihypertensive potential, it has the ability to prevent renal, coronary complications and cerebrovascular events, to influence the progression of atherosclerosis, the occurrence of new cases of diabetes and to achieve a statistically significant reduction in total mortality
Systemic Hypertension. 2018;15(4):92-96
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