Comparative assessment of blood pressure variability in the dynamics of treatment with fixed combinations of antihypertensive drugs
F.R. GUMEROV, S.D. MAYANSKAYA
Kazan State Medical University, Kazan
Contact details:
Gumerov F.R. — postgraduate student of the Department of Hospital TherapyAddress: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-937-777-08-12, e-mail: biz1994@yandex.ru
Increased variability of blood pressure (BPV) is associated with the development of cardiovascular complications regardless of the average blood pressure (BP) values. The problem of BPV remains open today. The conducted prospective studies confirm the significance of this indicator. However, such studies are few, while new information about this indicator will help determine the prognostic capability of modern antihypertensive drugs in preventing the progression of cardiovascular diseases.
The purpose — to comparatively assess BPV in patients with 2–3 degree hypertension, when taking two different fixed combinations (FC) of antihypertensive drug.
Material and methods. The study involved 80 patients who were divided into 2 groups of 40 people in a randomized manner. Group 1 took FC of losartan plus amlodipine. Group 2 took FC of losartan plus hydrochlorothiazide. With the help of an automatic tonometer with the function of BPV assessment, this indicator was determined before the start of treatment (first visit) and after 3 months (second visit). Systolic and diastolic BPV were evaluated during visits (short-term) and between visits (long-term).
Results. In each of the studied groups, a decrease in short-term BPV was registered during three months of treatment. When comparing two groups of patients receiving different FC of antihypertensive drugs, a statistically significant decrease in systolic and diastolic short-term BPV was achieved only when taking the FC of losartan plus amlodipine (p < 0.01). At the same time, the long-term BPV practically did not differ between the groups.
Conclusion. At the end of the three-month study, all patients reached the target blood pressure level. Short-term BPV decreased by the third month of treatment in both groups of patients. When comparing two groups receiving different FC of antihypertensive drug, a statistically significant decrease in short-term BPV was achieved when taking losartan with amlodipine. Long-term BPV, practically did not differ between the groups. The problem of the value of a short-term BPV currently remains open and requires further study.
Key words: blood pressure variability, fixed combinations, free combinations, losartan with amlodipine, losartan with hydrochlorothiazide.
REFERENCES
- Rothwell P.M., Howard S.C., Dolan E. et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet, 2010, vol. 375, pp. 895–905.
- Ostroumova O.D., Borisova E.V., Pavleeva E.E. Blood pressure variability. Intervisit variability of blood pressure. Kardiologiya, 2017, no. 11, pp. 68–75 (in Russ.).
- Rothwell P.M., Howard S.C., Dolan E. et al. Effects of betablockers and calcium channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol, 2010, vol. 9, pp. 469–480.
- Rakugi H., Ogihara T., Saruta T. et al. Preferable effects of olmesartan / calcium channel blocker to olmesartan / diuretic on blood pressure variability in very elderly hypertension: COLM study subanalysis. J Hypertens, 2015, vol. 33 (10), pp. 2165–2172.
- Muntner P., Whittle J., Lynch A.I. et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: A Cohort Study. Ann Intern Med, 2015, vol. 163 (5), pp. 329–338.
- Stevens S.L., Wood S., Koshiaris C. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ, 2016, vol. 9, p. i4098.
- Brazhnik V.A., Minushkina L.O., Galyavich A.S. et al. Intervisit variability of blood pressure and the risk of adverse outcomes in patients who have suffered an exacerbation of coronary heart disease. Arterial’naya gipertenziya, 2021, no. 2, pp. 206–215 (in Russ.).
- Schutte A.E., Kollias A., Stergiou G.S. Blood pressure and its variability: classic and novel measurement techniques. Nat Rev Cardiol, 2022, vol. 19 (10), pp. 643–654.
- Mancia G., Grassi Mancia G. Mechanisms and clinical implications of blood pressure variability. J Cardiovasc Pharmacol, 2000, vol. 35 (4), pp. 15–19.
- Sarafidis P.A., Ruilope L.M., Loutradis C. et al. Blood pressure variability increases with advancing chronic kidney disease stage: a cross-sectional analysis of 16 546 hypertensive patients. J Hypertens, 2018, vol. 36, pp. 1076–1085.
- Bilo G., Parati G. Blood pressure variability and kidney disease: another vicious cirle? J Hypertens, 2018, vol. 36 (5), pp. 1019–1021.
- Schillaci G., Pucci G., Parati G. Blood pressure variability: an additional target for antihypertensive treatment? Hypertension, 2011, vol. 58 (2), pp. 133–135.
- Stergiou G.S., Parati G. How to best assess blood pressure? The ongoing debate on the clinical value of blood pressure average and variability. Hypertension, 2011, vol. 57 (6), pp. 1041–1042.
- Zhang Y. et al. Effect of antihypertensive agents on blood pressure variability. The Natrilix SR versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study. Hypertension, 2011, vol. 58 (2), pp. 155–160.
- Parati G., Stergiou G.S., Dolan E. et al. Blood pressure variability: clinical relevance and application. J Clin Hypertens (Greenwich), 2018, vol. 20 (7), pp. 1133–1137.