Key result
Combined antihypertensive therapy is linked to target BP control and reduced maladaptive cardiovascular remodeling.
Why the study?
The study aimed to evaluate changes in structural and functional parameters of the heart and vessels in stage II hypertension under combined antihypertensive therapy according to LV remodeling and BP profile.
Does combined antihypertensive therapy improve blood pressure control and reduce cardiovascular remodelling in patients with stage II essential hypertension?
Observational (n=110)
Does combined antihypertensive therapy improve blood pressure control and reduce cardiovascular remodelling in patients with stage II essential hypertension?
A step-up combined antihypertensive regimen including bisoprolol, lisinopril, hydrochlorothiazide, and amlodipine effectively controls blood pressure and improves cardiovascular remodelling over 6 months in stage II hypertension.
May support step-up combination regimens in stage II hypertension; leaves open need for RCTs before practice change.
OBJECTIVE: The aim: To evaluate the dynamics of structural and functional parameters of the heart, vessels in patients with hypertension of the II-nd stage under the influence of combined antihypertensive treatment depending on the type of the left ventricle remodelling and the profile of blood pressure (BP). PATIENTS AND METHODS: Materials and methods: The study involved 110 patients with hypertension of the II-nd stage. The ambulatory blood pressure monitoring, echocardiography and Doppler examination of the shoulder arteries were performed. Initial treatment included bisoprolol, lisinopril, hydrochlorothiazide. With impossibility of BP lowering to the target level, amlodipine has been added. RESULTS: Results: higher levels of BP in the "non-dipper" patients have led to the development of more pronounced changes in the heart and vessels compared with "dipper" patients. Three-component therapy was effective in patients with lower BP. The prescription of amlodipine has been found to be necessary for the majority of "non-dipper" patients and for the minority of "dipper". Combined therapy effectively controlled the BP at the level of the target and contributed to a decrease in the displays of remodelling of the heart and blood vessels. CONCLUSION: Conclusions: combined therapy used for 6 months reduces displays of disadaptive heart and vascular remodelling, diastolic, endothelial dysfunction. With the lack of efficacy of the therapy, which includes bisoprolol, lisinopril, hydrochlorothiazide, the adding of amlodipine to it can reach the target level of BP.
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Niushko et al. (2020) conducted an observational in Essential hypertension of the II-nd stage (n=110). Combined antihypertensive therapy (bisoprolol, lisinopril, hydrochlorothiazide, +/- amlodipine) vs. Baseline was evaluated on Dynamics of structural and functional parameters of the heart and vessels. Combined antihypertensive therapy over 6 months effectively controlled blood pressure to target levels and significantly reduced signs of maladaptive heart and vascular remodeling, diastolic dysfunction, and endothelial dysfunction.
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