Antihypertensive and vasoprotective effectiveness of the chronopharmacotherapy in patients with arterial hypertension after acute cerebrovascular accident

Abstract

Aim. To evaluate the effectiveness of combined antihypertensive chronopharmacotherapy and estimate the daily blood pressure profile (BP) parameters, such as: stiffness of the vascular wall and central aortic pressure in patients with arterial hypertension (AH) who underwent transient ischemic attack (TIA) or ischemic stroke (IS). Materials and methods. 235 patients with hypertension who underwent acute cerebrovascular accident were examined. There were 116 patients with TIA and 119 with IS. All patients were randomized in 4 groups according to regimen of antihypertensive drugs combination. The 1st group (n = 59) included patients with AH, who underwent TIA and received indapamide retard 1.5 mg and valsartan 160 mg in the morning regiment of drug therapy. The 2 nd group (n = 57) included patients with AH, who underwent TIA and received indapamide retard 1.5 mg in the morning and valsartan 80 mg twice a day (morning and evening). The 3 rd group (n = 47) included patients with AH, who underwent IS and received indapamide retard 1.5 mg and valsartan at a dose of 160 mg in the morning. The 4th group (n = 56) included patients with AH, who underwent IS and received indapamide retard 1.5 mg in the morning and valsartan 80 mg twice a day (morning and evening). Ambulatory blood pressure monitoring (ABPM), central aortic pressure (CAP) measurement and vessel wall stiffness values were evaluated before treatment and after 12 months of therapy. Results. Before the start of combined antihypertensive chronopharmacotherapy, most of the parameters for ABPM, vessel wall stiffness values and CAP in groups 1 and 2, 3 and 4 were comparable. Achievement of the target level of BP after 8 weeks of treatment, was significantly more often in groups with a double sartan therapy (group 2 and group 4) in compare with its single time application only in the morning hours (group 1 and group 3) (p<0.05). Statistically significant positive dynamics of the main values of the daily profile of blood pressure, stiffness of the vascular wall and central aortic pressure (p <0,05) were registered in all groups. However, more pronounced decline of main parameters of ABPM, stiffness of the vascular wall and central aortic pressure values were noted in group with double use sartan therapy in compare with single time sartan therapy in the morning time. (p <0.05). Significant positive dynamics of the main values of the ABPM, stiffness of the vascular wall and CAP were registered in patients who underwent IS and received double application sartan therapy (4 th group) in compare with patients with TIA (2 nd group) (p = 0.02). Conclusion. Double use sartan therapy, combined with a thiazide diuretics in patients, who underwent IS or TIA more often promotes to get target values of blood pressure, improve the main values of the ABPM, stiffness of the vascular wall and CAP in compare with single time sartan therapy in the morning time.