Effective strategies for prevention of cardiovascular complications in elderly patients with arterial hypertension and obesity (clinical example)

The frequency of arterial hypertension has a clear tendency to increase with age. The presence of obesity imposes additional difficulties on the choice of antihypertensive therapy regimen due to the variety of pathophysiological mechanisms of raising blood pressure in patients with a combination of hypertension and obesity. This article presents the clinical case of a 68-year-old patient with hypertension and obesity, discusses a comprehensive approach that includes diet, regular physical activity, cognitive training and pharmacotherapy with the fixed combination of amlodipine with telmisartan and the imidazoline receptor agonist moxonidine. The choice of this combination is due to the following reasons: the ultra-prolonged action of both drugs, which allows you to control blood pressure during the day, including in the morning, when there is the greatest number of cardiovascular events; organoprotective properties; improving carbohydrate metabolism; reducing the risk of diabetes; antiatherosclerotic properties. The choice of moxonidine is due to the need of effective control of blood pressure, reduction of the activity of the sympathetic nervous system, because hypersympathicotonia is one of the central pathogenetic mechanisms for raising blood pressure in patients with hypertension and obesity, and the decrease in resting heart rate less than 80 bpm (an independent risk factor for cardiovascular complications in hypertension). Dietary recommendations will help to reduce body weight and blood pressure, slow the progression of atherosclerosis, prevent the development of cardiovascular catastrophes, and improve the quality of life. The aim of physical activity is reducing body weight, improve cognitive functions and reduce cardiovascular risks. Cognitive training will help improve cognitive function and, consequently, increase patient adherence to treatment. After six weeks of complex treatment, the patient noted the achievement of the target blood pressure, weight loss, improved mood, increased exercise tolerance, improved quality of life, as well as a decrease in proteinuria, which completely disappeared after another three months of therapy.