Assessment of the Changes in Blood Pressure Circadian Profile and Variability in Patients With Chronic Heart Failure and Arterial Hypertension During Combined Therapy Including Ivabradine

Aim. To assess the changes in blood pressure (BP) circadian profile and variability in patients with chronic heart failure (CHF) of ischemic etiology and arterial hypertension (HT) due to the complex therapy including ivabradine. Material and methods. Patients (n=90) with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM) was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively) as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively) and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016). More significant reduction in average daily and night systolic and diastolic BP (p=0.001), as well as daily and night BP variability (p=0.001) was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP) was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm.