International Medical Journal, Vol. 22., Iss. 4, 2016, P. 13−17.
DAILY BLOOD PRESSURE FEATURES IN PATIENTS WITH HYPERTENSION AND DYSLIPIDEMIA UNDER INFLUENCE OF TREATMENT
Sumy State University
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The purpose of the work was to study daily blood pressure features in patients with hypertension combined with dyslipidemia and without it, to assess the combination therapy effect of perindopril (ACE−inhibitor), nebivolol (beta−blocker) and atorvastatin (statin) on daily blood pressure profile and lipoprotein levels. The study involved 60 hypertensive patients aged 60−80 who were randomized into two groups according to the presence of dyslipidemia. Clinical efficacy of the treatment was assessed using a standard method of daily blood pressure (BP) monitoring before and 12 weeks after the treatment onset. There were four types of daily BP profiles: dipper, non−dipper, night−peaker, over−dipper. The level of cholesterol, HDL−cholesterol, triglycerides (TG) was determined using enzyme colorimetric method. VLDL−cholesterol level was calculated using the formula (Friedewald W.T.): TG ? 0.45; LDL−cholesterol level was calculated using the formula: LDL−cholesterol = cholesterol (HDL−cholesterol −− VLDL−cholesterol). The patients received perindopril 8 mg/day, nebivolol 5 mg/day, atorvastatin 10 mg/day. Statistical data processing was carried out using Statistica 6.0 for Windows. Combination of dyslipidemia and hypertension occurred in 30 (50 %) patients (group 1), hypertension without dyslipidemia was diagnosed in 30 (50 %) patients (group 2). Hypertension in patients lasted for 12,5±1,2 years. The initial level of daily systolic BP in group was 153.0 [145.0; 163.0] mmHg, after 12 weeks of treatment it reached 127.0 mmHg [118.0; 132.0] (p = 0.002), the average level of diastolic BP decreased from 93.0 [87.0; 98.0] to 78.0 [69.0; 84.0] mmHg (p = 0.003). In group 2 after 12 weeks of treatment, the average systolic BP decreased from 149.0 [142.0; 158.0] to 125.0 [118.0; 131.0] mmHg (p = 0.004), and diastolic BP from 89.0 [83.0; 95.0] mmHg to 73.0 [67.0; 82.0] (p = 0.003). Target BP (< 130/90 mmHg) was achieved in 24 patients of group 1 (80 %) and 25 patients 2 groups (83 %). The findings of monitoring blood pressure and lipid metabolism in patients with hypertension and dyslipidemia demonstrated that significantly reduced percentage of daily physiological CAT profile of the dipper ide4creased and the percentage of pathological types of night−peaker and non−dipper increased; the latter had a direct correlation with increased content lipid profile indicators. Combination therapy with perindopril, nebivolol, atorvastatin normalizes circadian rhythm of blood pressure and reduces atherogenic potential of blood plasma, which makes appropriate and pathogenically substantiated its use and allows reducing cardiovascular risk.
Key words: arterial hypertension, one day monitoring of blood pressure, variability of blood pressure, dyslipidemia.