Daily monitoring of blood pressure and its diagnostic and prognostic value in patients with hypertension associated with IHD under the influence of calcium antagonists

Abstract

Introduction. Significant progress in the treatment of arterial hypertension (AH) and coronary heart disease (CHD) is associated with the use of third-generation dihydropyridine calcium (AC) antagonists such as amlodipine and lercanidipine. To optimize their purpose, it is interesting to study their features at different times of the day. Purpose of the study of early and daily antihypertensive activity of amlodipine and lercanidipine in patients with arterial hypertension associated with IHD in individuals with preserved LV systolic function. Materials and methods. Measurement of DMAT indicators were carried out on the AVRM-02/M monitor of Meditech (Hungary) with a stable course of IHD in the dynamics of the examination (the first days of hospitalization and on the 10-14th day). Blood pressure registration was carried out on the patient's "non-working arm", and with asymmetry of measurements on the right and left arms of more than 10 mm Hg – on the arm with higher BP values. The cuff was fixed on the forearm 2 cm above the elbow bend. BP was measured every 15 minutes from 6.00 to 23.00 and every 30 minutes from 23.00 to 6.00. Research results. After 10-14 days of therapy, an insignificant decrease in the average daily DA was noted, to a greater extent, by 3.8% (p<0.05) in the candesartan group, by 6.6% (p<0.0003) in the lercanidipine group, while in the amlodipine group, the mean diastolic blood pressure did not change during the day after treatment. Instead, in the amlodipine group, the maximum SAT during the day significantly decreased by 8.4% (p<0.04), which was the largest decrease among the comparable groups, while in the lercanidipine group, this decrease reached only 5.5% (p<0.01). The difference in the decrease in the average daily maximum DAT in the lercanidipine group was also significantly highest, amounting to 20.7% (p<0.004). It should be noted that the maximum average BP was more affected by decreases in the lercanidipine group. And it was 14.7% (p<0.006) against 5.6% (p<0.0003) of the average AT during the day. A significant decrease in the average daily and maximum values of pulse pressure (PAP) as a determinant of probable complications of IHD was positive against the background of treatment with various ACs. In the amlodipine group, there was the largest decrease of 10.6% (p<0.04) and 8.5% (p<0.05). As for the minimum values of systolic and diastolic blood pressure, their level relative to the initial values decreased by the same percentage during the day. An unexpected decrease in mean heart rate in the group of patients treated with lercanidipine by 13.4% (p<0.02), while in the group of amlodipine and candesartan, the changes were insignificant. Conclusions. The early antihypertensive effect of AK in patients with hypertension with IHD is manifested by an increase in the daily BP index and a decrease in episodes of ischemia. Under the influence of lercanidipine, increased variability of SAT and DAT at night by 59.3% (p<0.05) and 41.8% (p<0.05), respectively, should be taken into account when choosing treatment tactics. To the same extent, the reduction of SRP SAT and DA when using lercanidipine and amlodipine reduces the risk of morning events. Based on this, it is better to recommend taking lercanidipine at night, and amlodipine is better in the morning.