arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2019-25-3-307-318arthyper-1812Research ArticleСтатьиArticlesМодификация суточного профиля артериального давления у больных гипертонической болезнью и сахарным диабетом 2-го типаModification of the daily blood pressure profile in hypertensive patients with type 2 diabetes mellitushttps://orcid.org/0000-0003-1059-8387ДрагуновД. О.DragunovD. O.

Драгунов Дмитрий Олегович — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней педиатрического факультета.

Ул. Павловская, д. 25, корп. 13, Москва, 113093

Dmitriy O. Dragunov  MD, PhD, Associate Professor, Department of Internal Medicine Propaedeutics, Pediatric Faculty.

25–13 Pavlovskaya str., Moscow,113093

tamops2211@gmail.comhttps://orcid.org/0000-0003-0823-9190СоколоваА. В.SokolovaA. V.

Соколова Анна Викторовна—кандидат медицинских наук, ассистент кафедры пропедевтики внутренних болезней педиатрического факультета.

Москва

Anna V Sokolova - MD, PhD, Assistant, Department of Internal Medicine Propedeutics of the Pediatric Faculty.

Moscow

sokolova2211@gmail.comhttps://orcid.org/0000-0002-6645-2515АрутюновГ. П.ArutyunovG. P.

Арутюнов Григорий Павлович — доктор медицинских наук, профессор, член-корреспондент РАН, заведующий кафедрой пропедевтики внутренних болезней педиатрического факультета.

Москва

Grigoriy P. Arutyunov - MD, PhD, DSc, Professor, Corresponding Member of the Russian Academy of Sciences, Head, Department of Internal Medicine Propaedeutics of the Pediatric Faculty.

arut@ossn.ruЛатышевТ. В.LatyshevT. V.

Латышев Тимофей Викторович — старший лаборант кафедры пропедевтики внутренних болезней педиатрического факультета.

Москва

Timofey V Latyshev - Senior Laboratory Assistant, Department of Internal Medicine Props of the Pediatric Faculty.

Moscow

tima@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияPirogov Russian National Research Medical University (RNRMU)Russian Federation201931082019253307318Copyright © Драгунов Д.О., Соколова А.В., Арутюнов Г.П., Латышев Т.В., 20192019Драгунов Д.О., Соколова А.В., Арутюнов Г.П., Латышев Т.В.Dragunov D.O., Sokolova A.V., Arutyunov G.P., Latyshev T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1812

Цель исследования — оценить влияние комбинаций препаратов азилсартана медоксомила / хлорта-лидона (Аз-М/Хл) и периндоприла аргинина / индапамида (Пр/Ин) на способность модифицировать суточный профиль артериального давления (АД) и уровень индекса аугментации (ИА) в аорте у пациентов с гипертонической болезнью (ГБ) 2-й степени, профилем АД “non-dipper” или “night-peaker” и сахарным диабетом (СД) 2-го типа.

Материалы и методы

Материалы и методы. В исследование был включен 51 пациент (25 пациентов в группе, получавших Аз-М/Хл, и 26 пациентов в группе, получавших Пр/Ин) с ГБ 2-й степени, неблагоприятным профилем АД “non-dipper” или “night-peaker”, СД 2-го типа в стадии компенсации, находившиеся на стабильной, но неэффективной антигипертензивной терапии в течение 3 месяцев до включения в исследование. Средний возраст пациентов составил 73 ± 11,7 года. Группы не отличались по основным клиническим характеристикам. Уровень потребления соли определяли с помощью опросника “Charlton: SaltScreener”. Суточное мониторирование АД определялось с помощью монитора АД BPLab® («Петр Телегин», Россия) с программным обеспечением Vasotens («Петр Телегин», Россия), позволяющим анализировать параметры центральной гемодинамики. Для статистической обработки полученных данных использовали программное обеспечение Statistica 10.0 и программную среду R с использованием пакетов readxl, psych, ggplot2, ggpubr, gridExtra.

Результаты

Результаты. Более 6 г соли в сутки употребляло 27 (53 %) пациентов: в группе Аз-М/Хл 14 (56 %) пациентов, в группе Пр/Ин 13 (50 %) пациентов. Среднее дневное АД в среднем в группе Аз-М/Хл 161,2/102 ± 8,77/9,31 мм рт. ст., в группе Пр/Ин 158,3/96,7 ± 10,4/7,21 мм рт. ст. (p > 0,05); среднесуточное систолическое АД (САД) 161,2/102,0 ± 8,8/9,3 и 158,3/96,7 ± 10,4/7,2 мм рт. ст. соответственно (p > 0,05); индекс аугментации в аорте — 4,88 ± 15,9 и 2,7 ± 10,9 % соответственно (p > 0,05). Суточный профиль АД “non-dipper” на момент рандомизации выявлен у 86,3 % (n = 44) пациентов, профиль “night-peaker” — у 13,7 % (n = 7) пациентов. На момент окончания исследования: целевого уровня АД достигли все пациенты; среднесуточное САД в группе Аз-М/Хл 130,2 ± 8,8 мм рт. ст., в группе Пр/Ин 139,9 ± 8,2 мм рт. ст. (W = 140, p-value = 0,000497); более значимое снижение артериальной жесткости выявлено у пациентов, получавших Аз-М/Хл; в группе Аз-М/Хл изменили профиль АД на “dipper” 18 (72 %) пациентов, в группе Пр/Ин — только 5 (19 %) пациентов.

Заключение

Заключение. Комбинация азилсартана медоксомила/хлорталидона продемонстрировала более значимое по сравнению с комбинацией периндоприла аргинина/индапамида: (1) снижение среднего АД за сутки; (2) влияние на модификацию суточного профиля АД; (3) изменение ИА в аорте.

Objective

Objective. To evaluate the effect of combinations azilsartan medoxomil / chlorthalidone (Az-M/Chl) vs. perindopril / indapamide (Pr / Yn) regarding the modification of the daily blood pressure profile (BP) and augmentation index level in hypertensive patients (hypertension 2nd degree, HTN), the blood pressure profile “nondipper” or “night-peaker” and type 2 diabetes mellitus (DM).

Design and methods

Design and methods. The study included 51 HTN (mean age 73 ± 11,7 years) patients (25 patients in the group Az-M / Chl and 26 patients in the group Pr / Yn, the groups were comparable by the main clinical parameters) with blood pressure profile “non-dipper” or “night-peaker”, DM (compensation stage). All patients have been receiving stable but ineffective antihypertensive therapy for at least 3 months before inclusion. The level of salt consumption was defined by the questionnaire “Charlton: SaltScreener”. Ambulatory 24-hour blood pressure monitoring (ABPM) was performed using BPLab® device (software Vasotens, Russia) which enables analysis of central hemodynamics. Statistica 10.0 software and software R using readxl, psych, ggplot2, ggpubr, gridExtra packages were used for statistical data processing.

Results

Results. Twenty-seven (53 %) patients reported consumption of more than 6 g of salt per day: 14 (56 %) patients in the Az-M / Chl group, and 13 (50 %) patients in the Pr / Yn group. Mean daily BP was 161,2 / 102 ± 8,77 / 9,31 mm Hg in the Az-M / Chl group, and 158,3 / 96,7 ± 10,4 / 7,21 mm Hg in the group Pr / In (p > 0,05); mean daily systolic BP (MAP) was 161,2/102,0 ± 8,8 / 9,3 mm Hg and 158,3 / 96,7 ± 10,4 / 7,2 mm Hg, respectively (p > 0,05); aortic augmentation index — 4,88 ± 15,9 % and 2,7 ± 10,9 %, respectively (p > 0,05). At randomization (baseline), the non-dipping BP profile was found in 86,3 % (n = 44) patients, and the night-peaker profile — in 13,7      % (n = 7) patients. At the final visit, all patients achieved target BP level; mean daily systolic BP was 130,2 ± 8,8 and 139,9 ± 8,2 mm Hg in the Az-M/Chl and Pr / In groups, respectively (W = 140, p-value = 0.000497). The Az-M / Chl group demonstrated a more significant reduction in arterial stiffness. In addition, in the AZ-M / Chl group, 18 (72 %) patients showed change to a dipping BP profile, while only 5 (19 %) patients demonstrated the change in the Pr / Yin group.

Conclusion

Conclusion. The combination of azilsartan medoxomil/chlorthalidone showed a more significant compared with the combination of perindopril/indapamide: (1) a decrease in mean blood pressure per day; (2) the effect on the modification of the daily profile of blood pressure; (3) alteration of GI in aorta.

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