arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2021-27-6-642-652arthyper-2175Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОптимизация контроля артериального давления, органопротекции и метаболических нарушений с помощью фиксированной комбинации азилсартана медоксомил + хлорталидон у пациентов с артериальной гипертензией после перенесенного тяжелого и крайне тяжелого COVID-19Blood pressure control, target organ protection and metabolic disorders control using a fixed combination of azilsartan medoxomil + chlorthalidone in hypertensive patients survived after severe and extremely severe COVID-19https://orcid.org/0000-0001-5981-1754НедогодаС. В.NedogodaS. V.

 доктор медицинских наук, профессор, заведующий кафедрой внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, DSc, Professor, Head, Department of Internal Diseases INMFO

1 Tsiolkovsky street, Volgograd, 400001 Russia 

nedogodasv@mail.ruhttps://orcid.org/0000-0003-4771-6025ЛедяеваА. А.LedyaevaA. A.

 кандидат медицинских наук, доцент кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, Associate Professor, Department of Internal Diseases 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

ledy-alla@yandex.ruhttps://orcid.org/0000-0002-6611-9165СаласюкА. С.SalasyukA. S.

 кандидат медицинских наук, доцент кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, Associate Professor, Department of Internal Diseases 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

salasyukas@outlook.comhttps://orcid.org/0000-0002-6740-8321ЧумачекЕ. В.ChumachekE. V.

 кандидат медицинских наук, доцент кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, Associate Professor, Department of Internal Diseases 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

elena-chumachek@yandex.ruhttps://orcid.org/0000-0002-0662-1217ЦомаВ. В.TsomaV. V.

 кандидат медицинских наук, доцент кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, Associate Professor, Department of Internal Diseases 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

vtsoma38@gmail.comhttps://orcid.org/0000-0002-0646-5824ЛутоваВ. О.LutovaV. O.

 кандидат медицинских наук, ассистент кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, Assistant, Department of Internal Diseases INMFO 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

3asabird@inbox.ruhttps://orcid.org/0000-0002-3498-7718ПоповаЕ. А.PopovaE. A.

 кандидат медицинских наук, ассистент кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, Associate Professor, Department of Internal Diseases 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

cutting_saw@mail.ruhttps://orcid.org/0000-0001-6321-7205ВласовД. С.VlasovD. S.

 аспирант кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, Postgraduate Student, Department of Internal Diseases of the INMFO 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

danilvlasov@mail.ruhttps://orcid.org/0000-0002-7075-1235БычковаО. И.BychkovaO. I.

 кандидат медицинских наук, подполковник медицинской службы, начальник Военно-медицинской службы 

Волгоград

MD, PhD, Lieutenant Colonel, Medical Service, Head, Military Medical Service

Volgograd 

bychkova_006@mail.ruhttps://orcid.org/0000-0002-7302-2257ЛабазниковаВ. В.LabaznikovaV. V.

 ординатор кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, Resident, Department of Internal Diseases INMFO 

1 Tsiolkovsky street, Volgograd, 400001 Russia 

viktoria@yahoo.comhttps://orcid.org/0000-0003-1343-1355ЕвдокимовК. С.EvdokimovK. S.

 доктор медицинских наук, ординатор кафедры внутренних болезней 

 ул. Циолковского, д. 1, Волгоград, Россия, 400001 

 MD, PhD, DSc, Resident, Department of Internal Diseases 

 1 Tsiolkovsky street, Volgograd, 400001 Russia 

k.s.evdokimov@gmail.comВолгоградский государственный медицинский университетРоссияVolgograd State Medical UniversityRussian FederationВоенно-медицинская служба Управления Федеральной службы безопасности Российской Федерации по Волгоградской областиРоссияFederal Security Service of Russia in the Volgograd Region Russian Federation202117032022276642652Copyright © Недогода С.В., Ледяева А.А., Саласюк А.С., Чумачек Е.В., Цома В.В., Лутова В.О., Попова Е.А., Власов Д.С., Бычкова О.И., Лабазникова В.В., Евдокимов К.С., 20222022Недогода С.В., Ледяева А.А., Саласюк А.С., Чумачек Е.В., Цома В.В., Лутова В.О., Попова Е.А., Власов Д.С., Бычкова О.И., Лабазникова В.В., Евдокимов К.С.Nedogoda S.V., Ledyaeva A.A., Salasyuk A.S., Chumachek E.V., Tsoma V.V., Lutova V.O., Popova E.A., Vlasov D.S., Bychkova O.I., Labaznikova V.V., Evdokimov K.S.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/2175А

А

Цель исследования — оценка возможности фиксированной комбинации азилсартана медоксомил + хлорталидон в достижении дополнительной ангиопротекции у пациентов с артериальной гипертензией (АГ) и высокой скоростью распространения пульсовой волны (СПВ) после подтвержденного перенесенного COVID-19, осложненного двусторонней полисегментарной вирусной пневмонией тяжелого или крайне тяжелого течения, для терапии которого была использована терапия генно-инженерными биологическими препаратами, ранее не получавших комбинированную антигипертензивную терапию.

Материалы и методы

Материалы и методы. В открытое наблюдательное исследование длительностью 12 недель были включены 30 пациентов, через 28–31 день после выписки из стационара после перенесенной новой коронавирусной инфекции тяжелого и крайне тяжелого течения, получавших или не получавших ранее антигипертензивную терапию. Пациентам проводились суточное мониторирование артериального давления (АД), аппланационная тонометрия (определение индекса аугментации и центрального АД), измерение СПВ, лабораторные тесты до и после перевода на фиксированную комбинацию азилсартана медоксомил + хлорталидон.

Результаты

Результаты. Исходно у пациентов отмечалось повышение офисного АД до 153,06/92,2 мм рт. ст. После назначения пациентам фиксированной комбинации азилсартана медоксомил + хлорталидон наблюдалось снижение систолического АД на 18,47% и диастолического АД на 16,24%. По данным СМАД, снижение САД составило 19,65% и ДАД — 24,68%, СПВ снизилась на 34,4%, индекс аугментации — на 9,42%, центральное систолическое АД — на 15,48 % (p < 0,05 для всех сравнений с исходным значением). Сосудистый возраст (СВ) исходно был повышен до 44,96 лет при паспортном возрасте 35,03 года. После окончания терапии отмечалось значительное снижение СВ до 38,74 лет (p < 0,01 для всех сравнений с исходным значением). Кроме того, значимо уменьшились уровни С-реактивного белка, фибриногена, Д-димера, мочевины, глюкозы, мочевой кислоты.

Выводы

Выводы. Фиксированная комбинация азилсартана медоксомил + хлорталидон обеспечивает лучший контроль АД, а также способствует улучшению показателей эластичности сосудов, а также уменьшению постинфекционного воспаления у пациентов с АГ после перенесенной коронавирусной инфекции тяжелого течения.

Objective

Objective. Evaluation of the possibility of a fixed combination of azilsartan medoxomil + chlorthalidone in additional angioprotection in patients with arterial hypertension (HTN) and high pulse wave velocity (PWV) after confirmed severe or extremely severe COVID-19 (bilateral polysegmental viral pneumonia) treated by genetically engineered biological drugs, who had not previously received combined antihypertensive therapy.

Design and methods

Design and methods. An open observational study lasting 12 weeks included 30 patients, 28–31 days after discharge from the hospital after a severe and extremely severe COVID-19, who received or had not previously received antihypertensive therapy. Patients underwent 24-hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), measurement of PWV, laboratory tests before and after prescription of a fixed combination of azilsartan medoxomil + chlorthalidone.

Results

Results. At baseline, patients showed an increase in office blood pressure to 153,06/92,2 mmHg. After treatment with a fixed combination of azilsartan medoxomil + chlorthalidone, a decrease in systolic BP by 18,47% and diastolic BP by 16,24% was observed. According to ambulatory BP monitoring, the decrease in systolic BP was 19,65% and diastolic BP — 24,68%, PWV decreased by 34,4%, augmentation index — by 9,42%, central systolic BP — by 15,48% (p < 0,05). At baseline, vascular age (VA) was increased to 44,96 years compared to the passport age of 35,03 years. After treatment, there was a significant decrease in VA to 38,74 years (p < 0,01). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, blood urea nitrogen and uric acid significantly decreased.

Conclusions

Conclusions. The fixed combination of azilsartan medoxomil + chlorthalidone provides better control of BP. It also helps to improve vascular elasticity (augmentation index, PWV, central systolic BP, decrease in VA) and to reduce post-infectious inflammation in HTN patients after a severe coronavirus infection.

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