arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2014-20-6-578-690arthyper-163Research ArticleК 55-летию медицинского факультета РУДНTo the 55-th anniversary of Medical Faculty of RPFUМОДУЛИРУЮЩИЙ ЭФФЕКТ ДОСТИЖЕНИЯ ЦЕЛЕВОГО АРТЕРИАЛЬНОГО ДАВЛЕНИЯ В ОТНОШЕНИИ СКОРОСТИ ПУЛЬСОВОЙ ВОЛНЫ У ПАЦИЕНТОВ С НЕОСЛОЖНЕННОЙ АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙMODULATING EFFECT OF TARGET BLOOD PRESSURE ACHIEVEMENT ON PULSE WAVE VELOCITY IN HYPERTENSIVE PATIENTSТроицкаяЕ. А.TroitskayaE. A.

MD, Assistant, Department of Propaedeutic of Internal Diseases

kotovskaya@bk.ruКотовскаяЮ. В.KotovskayaYu. V,.

Доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней.

Контактная информация: Котовская Юлия Викторовна, Городская клиническая больница № 64, кафедра пропедевтики внутренних болезней ФГБОУ ВПО «Российский университет дружбы народов» Минобрнауки России, ул. Вавилова, д. 61, Москва, Россия, 117292. E-mail: kotovskaya@bk.ru

Corresponding author: Julia V. Kotovskaya, MD, PhD, MDSc, Professor, Clinical Hospital № 64, Department of Internal Diseases Propaedeutics at Russian People’s Friendship University, 61 Vavilov st., Moscow, Russia, 117292. E‑mail: kotovskaya@bk.ru,

Professor, Department of Cardiology and Clinical Pharmacology, the Faculty of Advanced Training of Medical Workers

kotovskaya@bk.ruКобалаваЖ. Д.KobalavaZh. D.

MD, PhD, Professor, Head, Department of Propaedeutic of Internal diseases, Russian People’s Friendship University;

Head, Department of Cardiology and Clinical Pharmacology, the Faculty of Advanced Training of Medical Workers

kotovskaya@bk.ruРоссийский университет дружбы народов, МоскваРоссияRussian People’s Friendship University, MoscowRussian Federation201406032015206578590Copyright © Троицкая Е.А., Котовская Ю.В., Кобалава Ж.Д., 20152015Троицкая Е.А., Котовская Ю.В., Кобалава Ж.Д.Troitskaya E.A., Kotovskaya Y.V., Kobalava Z.D.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/163Цель исследования

Цель исследования. Изучить динамику скорости распространения пульсовой волны (СРПВ) при достижении целевого артериального давления (АД) на фоне комбинированной терапии блокатором ренин-ангиотензин-альдостероновой системы (РААС) и антагонистом кальция амлодипином и установить предикторы ее снижения у больных неосложненной артериальной гипертензией (АГ).

Материалы и методы

Материалы и методы. У 47 пациентов (20 — мужчины, средний возраст 58,9 ± 9,0 лет) с неосложненной АГ 1–2 степени, получавших комбинированную терапию блокатором РААС и амлодипином с возможным добавлением индапамида-ретард, достигших уровня АД < 140/90 мм рт. ст. не позднее, чем через 6 месяцев лечения, проводилась оценка клинического АД на каждом визите, суточное мониторирование АД (СМАД) и измерение артериальной ригидности методом аппланационной тонометрии исходно и в конце периода наблюдения.

Результаты

Результаты. Все пациенты достигли и поддерживали целевой уровень АД в течение 8 месяцев (исходное АД 163,4 ± 8,1/100,9 ±4,2 мм рт. ст.; конечное — 123,7 ± 9,7/76,8 ±6,7 мм рт. ст.). На фоне стойкого контроля АД у 11 (23 %) пациентов СРПВ снизилось на 1 м/с и более, у 15 (32 %) — не изменилось, у 21 (45 %) — повысилось. Группы были сопоставимы по основным клинико-демографическим параметрам, исходному и достигнутому АД и показателям СМАД. Выявлены различия по исходной СРПВ (15,9 ± 2,5 м/с; 13,6 ± 1,9 м/с и 10,9 ± 1,7 м/с соответственно, р <0,05). В группе снижения СРПВ или без ее существенного изменения доля пациентов, принимавших максимальные дозы блокаторов РААС и амлодипина, была значительно выше (72,7; 66,7 и 28,6 % соответственно, критерий Пирсона χ 2 = 9,0; р < 0,05). Корреляционный и многофакторный регрессионный анализ выявили обратные взаимосвязи между снижением СРПВ и дозами блокатора РААС (r = –0,5, β = –0,5) и амлодипина (r = –0,5, β = –0,39, p < 0,05).

Заключение

Заключение. Достижение и поддержание целевого АД у пациентов с неосложненной АГ обладает модулирующим эффектом в отношении артериальной ригидности, оцененной по СРПВ. Предикторами снижения артериальной ригидности являются более высокие дозы блокаторов РААС и амлодипина.

Objective. Carotid-femoral pulse wave velocity (PWV) is a strong independent predictor of cardiovascular morbidity and mortality. The aim of the study was to evaluate treatment-induced changes in PWV in hypertensive subjects achieved target clinic blood pressure (BP). Design and methods. Patients with grade I–II hypertension were treated to achieve target clinic BP < 140/90 mmHg with combination of RAAS-inhibitors and amlodipine for 1 year. Baseline BP was 163,4 ± 8,1/100,9 ± 4,2 mmHg; achieved BP 123,7 ± 9,7/76,8 ± 6,7mmHg. Central BP and PWV were measured before treatment and after 8 months of target clinic BP was maintained. Results. In 47 patients (20 men, age 58,9 ± 9,0 years) target clinic BP was achieved and maintained for 8 months. In 11 (23 %) subjects PWV decreased by ≥ 1 m/s from baseline (G1), in 15 (32 %) patients it remained unchanged (G2), and in 21 (45 %) it increased by ≥ 1 m/s compared to baseline (G3). The groups were comparable by age, risk factors, baseline and achieved clinic BP. PWV differed between the groups at baseline (G1 15,9 ± 2,5 vs. G2 13,6 ± 1,9 vs. G3 10,9 ± 1,7 m/s, р < 0,05), but not at the end of the study (13,0 ± 2,1; 13,6 ± 1,9 and 13,4 ± 1,9 m/s, respectively, p > 0,05). Also 72,7 % of patients in G1 and 66,7 % in G2 received the highest recommended doses of RAAS-inhibitors and amlodipine 10 mg vs. 28,6 % in G3 (Pearson χ 2 = 9,0; р < 0,05). Correlation and multiple regression analysis revealed the association between PWV decrease and doses of RAAS-inhibitors and amlodipine (r = –0,5, β = –0,45, p < 0,05). Conclusions. There is a modulating effect of target BP achievement on PWV in hypertensive subjects. PWV reduction is associated with higher doses of RAAS inhibitors and amlodipine.

артериальная гипертонияартериальная ригидностьскорость распространения пульсовой волныкомбинированная антигипертензивная терапияhypertensionarterial stiffnesspulse wave velocitycombined antihypertensive therapy.ReferencesРоссийское медицинское общество по артериальной гипертонии (РМОАГ), Всероссийское научное общество кардиологов (ВНОК). Диагностика и лечение артериальной гипертензии. Российские рекомендации (четвертый пересмотр). Системные гипертензии. 2010;3:5–26. [Russian society of arterial hypertension, Russian society of cardiology. Diagnosis and treatment of arterial hypertension. Russian guidelines. Systemic Hypertension. 2010;3:5–26. In Russian].Russian society of arterial hypertension, Russian society of cardiology. Diagnosis and treatment of arterial hypertension. Russian guidelines. Systemic Hypertension. 2010;3:5–26. In Russian.Mancia G, Backer GD, Dominiczak A et al. 2013 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–2219.Mancia G, Backer GD, Dominiczak A et al. 2013 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–2219.Boutouyrie P, Tropeano AI, Asmar R et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39(1):10–15.Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P et al. Aortic stiffness is an independent predictor of primary coronary eventsin hypertensive patients: a longitudinal study. Hypertension. 2002;39(1):10–15.Laurent S., Cockroft J, Van Bortel L et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–2605.Laurent S, Cockroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–2605.The CAFE Investigators, for the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Investigators. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study. Circulation. 2006;113(9):1213–1225.The CAFE Investigators, for the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Investigators. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study. Circulation. 2006;113(9):1213–1225.Boutouyrie P, Achouba A, Trunet P, Laurent S. Amlodipinevalsartan combination decreases central systolic blood pressure more effectively than the amlodipine-atenolol combination. The EXPLOR Study. Hypertension. 2010;55(6):1314–1322.Boutouyrie P, Achouba A, Trunet P, Laurent S. Amlodipine-valsartan combination decreases central systolic blood pressure more effectively than the amlodipine- atenolol combination. The EXPLOR Study. Hypertension. 2010;55 (6):1314–1322.Asmar RG, O’Rourke ME, Mallion JM et al. Amelioration of arterial properties with a perindopril-indapamide very-low-dose combination. J Hypertens. 2001;19 (4):15–20.Asmar RG, London GM, O’Rourke ME, Mallion JM, Romero R, Rahn KH et al. Amelioration of arterial properties with a perindopril-indapamide very-low-dose combination. J Hypertens. 2001;19(4):15–20.De Luca N, Asmar RG, London GM et al. Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril / indapamide in hypertensive subjects. J. Hypertens. 2004;22(8):1623–1630.De Luca N, Asmar RG, London GM, O’Rourke MF, Safar ME; REASON Project Investigators. Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects. J Hypertens. 2004;22(8):1623–1630.Kum F, Karalliedde J. Critical appraisal of the differential effects of antihypertensive agents on arterial stiffness. Integr Blood Press Control. 2010;3:63–71.Kum F, Karalliedde J. Critical appraisal of the differential effects of antihypertensive agents on arterial stiffness. Integr Blood Press Control. 2010;3:63–71.Mäki-Petäjä KM, Wilknson IB. Anti-inflammatory drugs and statins for arterial stiffness reduction. Curr Pharm Des. 2009;15 (3):290–303.Mäki-Petäjä KM, Wilknson IB. Anti-inflammatory drugs and statins for arterial stiffness reduction. Curr Pharm Des. 2009;15(3):290–303.Boutouyrie P. The reference values for arterial stiffness collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. Eur Heart J. 2010;31 (19):2338–2350.Boutouyrie P. The reference values for arterial stiffness collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. Eur Heart J. 2010;31(19):2338–2350.Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.Национальные рекомендации по диагностике и коррекции нарушений липидного обмена с целью профилактики и лечения атеросклероза, четвертый пересмотр. Российский кардиологический журнал. 2012;4: Приложение 1. [National guidelines on diagnosis and treatment of dyslipidemia and atherosclerosis. Russian journal of Cardiology. 2012;4: Suppl 1. In Russian].National guidelines on diagnosis and treatment of dyslipidemia and atherosclerosis. Russian journal of Cardiology. 2012;4: Suppl 1. In Russian.Safar M. De-stiffening drug therapy and blood pressure control. Integr Blood Press Control. 2010;3:1–9.Safar M. De-stiffening drug therapy and blood pressure control. Integr Blood Press Control. 2010;3:1–9.Asmar R. Effect of antihypertensive agents on arterial stiffness as evaluated by pulse wave velocity: clinical implications. Am J Cardiovasc Drugs. 2001;1 (5):387–397.Asmar R. Effect of antihypertensive agents on arterial stiffness as evaluated by pulse wave velocity: clinical implications. Am J Cardiovasc Drugs. 2001;1(5):387–397.Laurent S, Kingwell B, Bank A et al. Clinical applications of arterial stiffness: therapeutics and pharmacology. Am J Hypertens. 2002;15:453–458.Laurent S, Kingwell B, Bank A, Weber M, Struijker-Boudier H. Clinical applications of arterial stiffness: therapeutics and pharmacology. Am J Hypertens. 2002;15 (5):453–458.Asmar R. Arterial stiffness and pulse wave velocity — clinical applications. Paris: Elsevier. 1999. P. 9–43.Asmar R. Arterial stiffness and pulse wave velocity — clinical applications. Paris: Elsevier. 1999:9–43.Asmar R. Pulse wave velocity. Principles and measurements. In Safar ME (ed). Arterial stiffness and pulse wave velocity — clinical applications. Paris: Elsevier. 1999. P. 25–53.Asmar R. Pulse wave velocity. Principles and measurements. In Safar ME (ed). Arterial stiffness and pulse wave velocity — clinical applications. Paris: Elsevier. 1999:25–53.Asmar R. Pulse wave velocity and therapy. In Safar ME (ed). Arterial stiffness and pulse wave velocity — clinical applications. Paris: Elsevier. 1999. P. 143–157.Asmar R. Pulse wave velocity and therapy. In Safar ME (ed). Arterial stiffness and pulse wave velocity — clinical applications. Paris: Elsevier. 1999:143–157.Topouchian J, Feghali RE, Pannier B et al. Arterial stiffness and pharmacological interventions — the TRanscend Arterial stiffNess Substudy (TRANS study). Vasc Health Risk Manag. 2007;3(4):381–388.Topouchian J, Feghali RE, Pannier B, Wang S, Zhao F, Smetana K et al. Arterial stiffness and pharmacological interventions — the TRanscend Arterial stiffNess Substudy (TRANS study). Vasc Health Risk Manag. 2007;3 (4):381–388.Lacourcière Y, Beliveau R, Conter HS et al. Effects of perindopril on elastic and structural properties of large arteries in essential hypertension. Can J Cardiol. 2004;20 (8):795–799.Lacourcière Y, Beliveau R, Conter HS, Burgess ED, Lepage S, Pesant Y et al. Effects of perindopril on elastic and structural properties of large arteries in essential hypertension. Can J Cardiol. 2004;20(8):795–799.Ong KT, Delerme S, Pannier B. Aortic stiffness is reduced beyond blood pressure lowering by short-term and long-term antihypertensive treatment: a meta-analysis of individual data in 294 patients. J Hypertens. 2011;29 (6):1034–1042.Ong KT, Delerme S, Pannier B. Aortic stiffness is reduced beyond blood pressure lowering by short-term and long-term antihypertensive treatment: a meta-analysis of individual data in 294 patients. J Hypertens. 2011;29 (6):1034–1042.Boutouyrie P, Lacolley P, Briet M. Pharmacological modulation of arterial stiffness. Drugs. 2011;71(13):1689–1701.Boutouyrie P, Lacolley P, Briet M. Pharmacological modulation of arterial stiffness. Drugs. 2011;71 (13):1689–1701.

The authors declare that there are no conflicts of interest present.