Key result
Switching to a combination of perindopril and amlodipine significantly reduced daytime systolic blood pressure (130.5 vs 142.0 mmHg) and decreased blood pressure variability compared to prior therapy with ARBs and diuretics in patients with stage II arterial hypertension.
Why the study?
To analyze 24-hour ambulatory blood pressure monitoring readings in patients with stage II HTN receiving antihypertensive therapy to plan a personalized outpatient management algorithm.
Does switching to a combination of perindopril and amlodipine improve 24-hour ambulatory blood pressure profiles in patients with stage II hypertension uncontrolled on ARBs and diuretics?
Observational (n=60)
No
Does switching to a combination of perindopril and amlodipine improve 24-hour ambulatory blood pressure profiles in patients with stage II hypertension uncontrolled on ARBs and diuretics?
Switching from ARBs and diuretics to a fixed combination of perindopril and amlodipine improves 24-hour BP profiles and reduces BP variability in patients with uncontrolled stage II hypertension.
May support ABPM-guided personalization of stage II HTN therapy; leaves open confirmation in prospective trials.
The aim of the study:to analyze ABPM readings in patients with stage II HTN receiving antihypertensive therapy in order to plan a personalized algorithm for managing HTN patients at the stage of the outpatient care. Materials and methods. 60 patients with stage II HTN were examined. ABPM readings were assessed on the background of planned antihypertensive therapy (ARBs and diuretics) and after the adjustment of the therapy (perindopril and amlodipine).Results. The use of long period monitoring provides comprehensive information about the patterns of blood pressure changesthroughout the day. Patients with stage II HTN receiving planned antihypertensive therapy with ARBs and diuretics did not have targeted BP during the day and had a systolic HTN of stage I, while there was a statistically significant increase in BP variability during the day and in the readings indicating a hypertensive load of target organs in comparison with a group of patients receiving a combination of perindopril and amlodipine for 3 months. In addition, there was a statistically significant (ANOVA, p<0.05) difference in the rate of morning BP rise, which can serve as a precursor for the development of cardiovascular events in the morning compared to the group of patients with theadjusted therapy. Among hypertensive patients receiving ARBs and diuretics a disturbed circadian rhythm predominated in the structure of the diurnal BP profilecompared with the patients who received combined therapy with perindopril and amlodipine. In addition, the proportion of night-peakers among patients taking ARBs and diuretics was 2 times higher than among patients whose therapywas adjusted 3 months ago.Conclusion. Thus, in the group of patients whose antihypertensive therapy was timely adjusted, there was an improvement in hemodynamics: due to the achievement of targeteddiurnal blood pressurereadings, a significant decrease in BP variability during the day and the rate of the morning rise in blood pressure, as well as the proportion of patients with a normal diurnal blood pressure profileincreased.
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Nilova et al. (2022) conducted an observational in Stage II arterial hypertension (n=60). Perindopril and amlodipine vs. ARBs and diuretics was evaluated on Daytime systolic blood pressure (mmHg) (p=<0.05). Switching to a combination of perindopril and amlodipine significantly reduced daytime systolic blood pressure (130.5 vs 142.0 mmHg) and decreased blood pressure variability compared to prior therapy with ARBs and diuretics in patients with stage II arterial hypertension.
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