Three-year dynamics of left ventricular structural parameters in patients with resistant arterial hypertension on four-component therapy
Keywords:resistant arterial hypertension, left ventricular hypertrophy, antihypertensive agents
Aim. To study the three-year dynamics of left ventricular (LV) structural parameters with the four-component antihypertensive therapy in patients with resistant arterial hypertension (RAH).
Material and methods. A total of 102 patients with true RAH were included. The duration of the treatment was 3.2 ± 0.1 years. Patients received triple single-pill combination of antihypertensive drugs (TSPC), which was alternately added by spironolactone, eplerenone, moxonidine, torasemide, or nebivolol for three-months treatment. Than patients received the TSPC with an addition of the most effective of the four medications listed. Office and ambulatory blood pressure (BP) measurements and echocardiography were performed, clinical characteristics; specifics of neurohumoral and proinflammatory status were assessed.
Results. The patients were divided into 2 groups according to the changes in LV mass index (LVMI) within three years. The 1st group included 68 patients who demonstrated regression of LV hypertrophy (LVH). The 2nd group included 28 patients who had LVMI unchanged or increased. LVMI was normalized in 38.2 % of patients, and a degree of LVH was reduced from severe to moderate in 61.8 % of patients in achieving the target BP level in 44 % of patients and restoring the physiological 24-hour BP rhythm in 39 % of patients. In the 2nd group, 28.6 % of patients achieved BP targets; a large proportion of them were patients with concomitant coronary heart disease (42.3 %) and chronic kidney disease (64.3 %).
Conclusions. Effective antihypertensive therapy providing 24-hour BP control and restoring the physiological 24-hour BP rhythm contributes to LVH regression in 66.7 % of patients with RAH. Higher baseline LVMI (β = 0.655; P < 0.0001) and plasma active renin (β = 0.442; P = 0.005), lower 24-hour urinary albumin excretion rate (β = -0.475; P < 0.0001) are independent predictors of LVH regression in RAH patients.
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