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Mar 18th

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Optimal choice of antihypertensive therapy on results of blood pressure monitoring in patients with ischemic stroke in history

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Turna E. U., Kryuchkova O. N.

SI «Crimea State Medical University named after S. I. Georgievsky», Simferopol, Crimea

SUMMARY

Goal of research. The aim of our study was to investigate the effect of different variants of combined antihypertensive therapy on the dynamics of the circadian rhythm of blood pressure for rehabilitation of patients in case of hypertension with ischemic stroke in history.

Materials and methods. In the study group – 75 patients (male and female, age 60,85 ± 0,96) with stage 1 and 2 of hypertension and ischemic stroke in history who were randomized into two groups (gr): A – 37 patients, administered combination of olmesartan and hydrochlorothiazide in therapeutic doses, gr. B – 38 patients, administered of olmesartan and amlodipine combination. A comparison group – 30 patient with stage II 1 and 2 degree. All patients underwent blood pressure monitoring. All patients underwent blood pressure monitoring. Estimation of the ABP in the study group were conducted at baseline and one year on antihypertensive therapy. Statistical analysis was performed using variation statistics using the package «Statistica 10».

Results. After a year in therapy we have evaluated the effects of antihypertensive drug combinations studied. It was found that in group A daily average of systolic and diastolic blood pressure were (118,8 ± 1,23 and 74,95 ± 0,94 mm Hg), in group B – (121,2 ± 1,28 and 72,16 ± 1,2 mm Hg, respectively, p > 0.05), indicating a comparable antihypertensive effect combinations of olmesartan + amlodipine (OLM + AML) and olmesartan + hydrochlorothiazide (OLM + HCTZ). The combination OLM + AML caused a statistically significant reduction in variability of systolic blood pressure per night and in the daytime, treatment with the combination of OLM + HCTZ did not cause statistically significant changes in this index. The combination OLM + AML reduced variability of systolic blood pressure per day by 5 points (before treatment was 17,38 ± 0,72 mm Hg, the therapy – 12,41 ± 0,53 mm Hg, p < 0.0005) during therapy with OLM + HCTZ observed not statistically significant reduction in variability of systolic blood pressure (before treatment in group A – 17,64 ± 0,98 mm Hg, the therapy – 15,82 ± 0,75 mm Hg, p > 0.05). In comparative evaluation of the effectiveness of combined antihypertensive therapy in groups A and B showed a more pronounced (not statistically significant) decrease pulse pressure per day, daytime and night-time in group A during therapy with OLM + HCTZ (pulse pressure per night in group A before treatment was 57,24 ± 1,87 mm Hg, during the therapy – 42,61 ± 1,13 mm Hg, p < 0.01). In group B, no statistically significant effect of the combination of OLM + AML on the dynamics pulse pressure (before treatment pulse pressure at night in group B was 56,81 ± 1,17 mm Hg, during the therapy – 54,08 ± 0,76 mm Hg, p = 0.0548).

Conclusions. The use of the investigated schemes antihypertensive therapy was accompanied by a comparable antihypertensive effect. The combination of amlodipine and olmesartan promoted statistically significant reduction in systolic blood pressure variability per day. The combination of olmesartan and hydrochlorothiazide was accompanied by a marked reduction in pulse pressure for a day, day and night.

Keywords: stroke, hypertension, blood pressure monitoring, treatment.