The influence of the combined antihypertensive therapy on the results of daily monitoring of blood pressure and cerebral blood flow in patients with hypertension and ischemic stroke in history.
DOI:
https://doi.org/10.14739/2310-1210.2013.4.16833Keywords:
hypertension, stroke, blood pressure monitoring, cerebral hemodynamics, combination antihypertensive therapyAbstract
hemodynamics, combination antihypertensive therapy.
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 and cerebral blood flow in patients with hypertension and 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. And comparison group - 30 patient with stage II 1 and 2 degree. All patients underwent blood pressure monitoring, Doppler examination of the cerebral blood vessels. Estimation of the ABP and cerebral hemodynamics in the study group were conducted at baseline and one year on antihypertensive therapy. Statistical analysis was performed using variation statistics with package «Statistica 10".
Results: After year therapy we have evaluated the effects of studied antihypertensive drug combinations. It was found that in group A daily average of SBP and DBP were 118,8 ± 1,23 and 74,95 ± 0,94 mm Hg. Art., Group B - 121,2 ± 1,28 and 72,16 ± 1,2 mm Hg. Art. respectively (p> 0.05), indicating a comparable antihypertensive effect combinations of olmesartan + amlodipine and olmesartan + hydrochlorothiazide. The combination OLM + AML reduced variability of systolic blood pressure per day by 5 points (before treatment was 17,38 ± 0,72, after therapy - 12,41 ± 0,53, p <0.0005) Before treatment in group A - 17,64 ± 0,98, after therapy - 15,82 ± 0,75, p> 0.05. In comparative evaluation of the effectiveness of combined antihypertensive therapy in groups A and B showed 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). Before treatment pulse pressure at night in group B was 56,81 ± 1,17 mm Hg., during the therapy - 54,08 ± 0,76 , p = 0.0548.
In the analysis of cerebral hemodynamic reserve in group A during therapy with olmesartan and hydrochlorothiazide revealed an increase of peak systolic flow velocity after hypercapnia test right at 3.5% and left 3,2% (98,61 ± 3,46 and 99,75 ± 3 , 04 cm / s, respectively), the increase in end-diastolic flow velocity in the ACM in Group A on therapy was 8.4% on the right and 9,2% (40,34 ± 1,75 and 41,26 ± 1,88 cm / s, respectively), which was not statistically significant with the indicators of growth velocity parameters before treatment.
Conclusions: Combined antihypertensive therapy with amlodipine olmesartan leaded to the significantly reduce of the systolic BAP for the day, as well as reduced vasospasm (Lindegard’s index) and an increase of cerebral reserve, which indicates reduction in stiffness of medium-caliber vessels. The therapy with olmesartan and hydrochlorothiazide resulted in a significant decrease in pulse pressure during the day.
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