International Medical Journal, Vol. 24., Iss. 1, 2018, P. 19−24.
MODERN VIEW ON THE CAPABILITIES OF ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH A COMBINATION OF ARTERIAL HYPERTENSION AND BRONCHIAL ASTHMA (literature review)
Nizhny Novgorod State Medical Academy
Kirov State Medical University, Russian Federation
One of the features in clinical presentation of internal diseases is polymorbidity. The interaction of medical conditions significantly changes the prior disease progression, the severity and kind of the complications, worsens the life quality of the patient, restricts or complicates the diagnostic and treatment procedure. According to a number of authors, arterial hypertension (AH) is combined with broncho−obstructive diseases in 34.3 % of cases. Over the recent years, a significant increase was observed in the proportion of patients with combination of these diseases. The causes of the interaction of AH and bronchial asthma (BA) are complicated and are under investigation. The presence of low−intensity inflammation and oxygen deficiency in BA can accelerate development of AH, atherosclerotic vessel changes, left ventricular hypertrophy (LVH), involvement of right heart with the formation of chronic cor pulmonale and cardiac rhythm disturbances. In turn, a stable increase in systemic arterial pressure (AD) in BA contributes to the post−capillary pulmonary hypertension (PH), edema of interstitium and pneumonosclerosis with fixation of inconvertible components of bronchial obstruction. The literature data show that an increase in the heart rate (HR) and a tendency to heart consciousness is typical for the patients with BA. It was shown that increased heart rate is an independent mortality risk factor. At the present calcium channel blockers of the non−dihydropyridine series are the drugs of choice in patients with AH associated with BA, they have a dilatant effect on the vessels of the pulmonary circulation and have the properties of bronchodilators, decrease the heart rate. Modern thiazide−like diuretics can be effectively used in patients with combination of AH and BA. It is known that indapamide has a significant protective effect on target organs, it leads to LVH regression, has an angioprotective, direct vasodilator effect. Indapamide also has antioxidant properties and produces antisclerotic effects. At present great attention is paid to prevention of chronic heart failure (CHF) with a preserved left ventricular ejection fraction (LVEF). Treatment options that prevent heart remodeling in patients with a combination of BA and AH and therefore prevent the development of CHF with a preserved LVEF are actively studied. In general, the questionable situation in respect of treatment approaches in patients with associated cardiovascular and bronchopulmonary diseases is the basis for further study of this problem.
Key words: arterial hypertension, bronchial asthma, cardiac rhythm disorders, antihypertensive therapy.