Preview

Rational Pharmacotherapy in Cardiology

Advanced search

HYPERTENSION AND DIABETES MELLITUS TYPE 2

https://doi.org/10.20996/1819-6446-2018-14-2-217-222

Full Text:

Abstract

Aim. To study the effect of long-term combined antihypertensive therapy with lisinopril plus amlodipine on the parameters of central aortic pressure (CAD) and visceral obesity in patients with arterial hypertension (HT) combined with type 2 diabetes mellitus (DM).

Material and methods. 30 patients with stage III of HT and DM type 2 aged 40-65 years were included into the study. After "washout period", combined therapy with amlodipine 6.2Ѓ}2.5 mg/day and lisinopril 12.3Ѓ}5.0 mg/day was prescribed, hypolipidemic therapy with atorvastatin 17.0Ѓ}4.7 mg/day and combined hypoglycemic therapy with metformin 1093.8Ѓ}253.6 mg/day and gliclazide 82.1Ѓ}38.5 mg/day were continued within 24 weeks. Initially, and after 24 weeks, a standard physical examination, 24-hour CAP parameters monitoring, body composition analysis with a percentage of visceral fat calculation, a visceral fat index (VAI) determination, the degree of adipose tissue dysfunction and the level of glycated hemoglobin (HbA1c) assessment were performed.

Results. Because of long-term therapy with lisinopril + amlodipine, a significant decrease in the level of office systolic (SBP) and diastolic blood pressure (DBP) by 22.3 and 12.5%, respectively, heart rate by 9,8%, and HbA1C level by 1.4% was found in comparison with the initial values. According to bioimpedanceometry a statistically significant decrease in the percentage of visceral fat (by 13.6%) was revealed, as well as VAI (by 22.5%) and the percentage of patients with very high visceral fat (Δ%=-36.7, р<0.05). Indicators of central hemodynamics were significantly improved in the form of decrease in the average daily, daytime and nighttime values of aortic SBP, DBP, pulse blood pressure, and augmentation index.

Conclusions. Thus, long-term combined therapy with lisinopril and amlodipine has shown not only high antihypertensive efficacy and the ability to reliably improve the parameters of CAD, but also to reduce the activity of visceral obesity, providing an additional positive metabolic effect without adjusting the dose of statins and hypoglycemic drugs.

About the Authors

M. E. Statsenko
Volgograd State Medical University
Russian Federation

Michael E. Statsenko – MD, PhD, Professor, Vice-Rector for Research, Head of Chair of Internal Medicine, Faculties of Pediatrics and Dentistry

Pavshikh Bortsov pl. 1, Volgograd, 400131



M. V. Derevyanchenko
Volgograd State Medical University
Russian Federation

Maria V. Derevyanchenko – MD, PhD, Associate Professor, Chair of Internal Medicine, Faculties of Pediatrics and Dentistry

Pavshikh Bortsov pl. 1, Volgograd, 400131



References

1. Nedogoda S.V., Barykina I.N., Salasyuk A.S. National clinical recommendations for obesity: concept and perspectives. Vestnik Volgogradskogo Gosudarstvennogo Meditsinskogo Universiteta. 2017;1(61):134-40. (In Russ.)

2. Shlyakhto E.V., Nedogoda S.V., Konradi A.O. Diagnosis, treatment, prevention of obesity and associated diseases. National clinical guidelines. Available at: http//www.scardio.ru/content/Guidelines/project/Ozhirenie_klin_rek_proekt.pdf.Checked by Apr 18, 2018 (In Russ.)

3. Jensen M.D., Ryan D.H., Apovian C.M., et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-38. doi: 10.1161/01.cir.0000437739.71477.ee.

4. Guo F., Garvey W.T. Development of a Weighted Cardiometabolic Disease Staging (CMDS) System for the Prediction of Future Diabetes. The Journal of Clinical Endocrinology and Metabolism. 2015;100(10):3871-77. doi: 10.1210/jc.2015-2691.

5. Guo F., Moellering D.R., Garvey W.T. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity. 2014;22(1):110-118. doi: 10.1002/oby.20585.

6. Statsenko M.E., Derevyanchenko M.V. Cardionephrotoprotection is the most important task of antihypertensive therapy in patients with type 2 diabetes mellitus. Kardiologiia. 2015:55(8):43-8. (In Russ.)

7. Statsenko M.E., Derevyanchenko M.V. Metabolic effects of combined antihypertensive therapy in patients with type 2 diabetes mellitus. Rational Pharmacotherapy in Cardiology. 2015:11(1):36-9. (In Russ.)

8. Statsenko M.E., Derevyanchenko M.V., Pastukhova O.R. The effect of combined antihypertensive therapy on the ambulatory profile of blood pressure and metabolic parameters in patients with type 2 diabetes mellitus. Kardiologiia. 2014:54(11):20-4. (In Russ.)

9. Statsenko M.E., Derevyanchenko M.V. Features of management of patients with arterial hypertension and type 2 diabetes mellitus: a view of the cardiologist. Farmateka. 2013:16(269):52-7. (In Russ.)

10. Reisin E., Weir M.R., Falkner B., et al. Lisinopril versus hydrochlorothiazide in obese hypertensive patients: a multicenter placebo-controlled trial. Treatment in Obese Patients With Hypertension (TROPHY) Study Group. Hypertension. 1997:30(1 Pt 1):140-5. doi: 10.1161/01.HYP.30.1.140.

11. Drapkina O.M., Korneeva O.N. Diroton in the treatment of arterial hypertension in patients with metabolic syndrome and non-alcoholic fatty liver disease (study ≪DIRIZHER≫). Rossiyskiye Meditsinskiye Vesti. 2013:18(3):41-9. (In Russ.)

12. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J. 2013,34:2159219. doi:10.1093/eurheartj/eht151.

13. Amato M.C. Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis. 2011:10(183):1-8.

14. Statsenko M.E., Derevyanchenko M.V. Daily profile of blood pressure, morphofunctional parameters of the heart, kidneys and metabolism in arterial hypertension in patients with secondary chronic pyelonephritis. Arterial'naya Gipertenziya. 2010:16(3):256-60. (In Russ.)

15. Statsenko M.E., Derevyanchenko M.V., Ostrovsky O.V., et al. Endothelial dysfunction is a target for combination antihypertensive therapy in patients with arterial hypertension and type 2 diabetes. Ter Arkhiv. 2013:85(9):63-8. (In Russ.)

16. Statsenko M.E., Turkina S.V., Tyshchenko I.A., et al. Visceral obesity as a marker of multi-organ damage risk. Vestnik Volgogradskogo Gosudarstvennogo Meditsinskogo Universiteta. 2017:1(61):105. (In Russ.)

17. Drapkina O.M., Korneeva O.N. A fixed-dose combination of amlodipine and lisinopril: the advantages of its use in metabolic syndrome. Vrach. 2012:12:42-5. (In Russ.)


For citation:


Statsenko M.E., Derevyanchenko M.V. HYPERTENSION AND DIABETES MELLITUS TYPE 2. Rational Pharmacotherapy in Cardiology. 2018;14(2):217-222. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-2-217-222

Views: 219


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)