Evaluating the Impact of Monoand Combination Antihypertensive Therapy with Dihydropyridine and Non-dihydropiridine Calcium Channel Blockers on the Parameters of Office Blood Pressure and Blood Pressure in Daily Monitoring in Patients with Mild to Moderate Hypertension
Introduction. The choice of treatment for arterial hypertension (AH) is based on the previous experience of using the drugs in a specific patient, profiles of cardiovascular risk, the presence of target organ damage, cardiovascular diseases, kidney diseases and diabetes mellitus. Typically, one patient has multiple risk factors, so the treatment of AH should be differentiated, often resorting to combination therapy. The advantage of combination therapy is that the simultaneous use of two different drugs is not only reduce the blood pressure (BP) more actively, but also provides the impact on different pathogenic mechanisms of hypertension. This enables to more effectively prevent target organ damage, as well as reduce side effects. Objective. This study was aimed to compare the effectiveness of lerkanidipin and diltiazem combination at different doses in patients with mild to moderate AH in terms of the effects on office BP and BP in daily monitoring. Materials and methods. The study included 123 patients with mild to moderate AH: the average office systolic (SBP)/diastolic BP (DBP) - 149.12/91.92 ± 1.42/0.93 mmHg. Average age of patients was 51.83 ± 0.86 yearss. All patients were divided into the groups of therapy. The first group (n = 20) - patients received diltiazem at a dose of 240 mg per day in two divided doses. The second group (n = 20) - patients were administered lercanidipin 20 mg once daily. The third group (n = 22) - patients received non-fixed combination of 20 mg lercanidipin and 240 mg diltiazem a day. The fourth group (n = 20) - patients were administered non-fixed combination of 10 mg lercanidipin and 240 mg diltiazem a day. The fifth group (n = 21) - patients received non-fixed combination of 10 mg lercanidipin and 120 mg diltiazem per day. The sixth group (n = 20) - patients were administered non-fixed combination of 20 mg lercanidipin and 120 mg diltiazem a day. All patients at baseline in and end of treatment underwent the following studies: measurement of body weight and height, calculation of body mass index. We have carried out office SBP, DBP and heart rate measurement, ambulatory BP monitoring (ABPM), biochemical blood assay, which included determination of total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, atherogenic index. Duration of treatment was 1 month. Results. After analyzing all the data, it was found that the indices of office SBP and DBP significantly decreased in patients with both mild and moderate hypertension in all groups almost equally. After 1 month of treatment: in the group of diltiazem 240 mg, office SBP/DBP was significantly decreased by 9.94/9.89 mmHg; in the group of 20 mg lercanidipine - by 12.35/8.18 mmHg; in the group of combination «ercanidipine 20 mg/diltiazem 240 mg» - by 12.75/8.19 mmHg; in the group of combination «lercanidipine 10 mg/diltiazem 240 mg» - by 11.60/8.33 mmHg; in the group of combination «lercanidipine 10 mg/diltiazem 120 mg» - by 11.68/9.84 mmHg; in the group of combination «lercanidipine 20 mg/diltiazem 120 mg» - by 13.88/9.76 mmHg. That is, all selected treatment regimens were equally effective in reducing office BP. According to the data of ABPM, combination therapy based on lercanidipine and diltiazem was as effective as the treatment on the basis of monotherapy with lercanidipine and diltiazem: in diltiazem 240 mg group, 24SBP/DBP decreased significantly by 11.92/7.22 mmHg, in a group of lercanidipine 20 mg - by 8.65/9.06 mmHg; in the group of combination «lercanidipine 20 mg/diltiazem 240 mg» - by 6.10/6.94 mmHg; in the group of combination «lercanidipine 10 mg/diltiazem 240 mg» - by 8.96/5.54 mm Hg; in the group of combination «lercanidipine 10 mg/diltiazem 120 mg» - by 7.21/5.47 mmHg; in the group of combination «lercanidipine 20 mg/diltiazem 120 mg» - by 6.81/7.89 mmHg. So, all selected treatment regimens were equally effective in reducing blood pressure daily. Achieving the target levels of office BP and BP at ABPM was the same in all treatment groups. In the group of diltiazem 240 mg both office BP and BP in ABPM was achieved in 72.23 % of patients. In lercanidipine group, both office BP and BP in ABPM was achieved in 76.47 % of patients. In the group of combination «lercanidipine 20 mg/diltiazem 240 mg», target office BP target was achieved in 56.25 % of patients, and target BP in ABPM - in 62.50 % of patients. In the group of combination «lercanidipine 10 mg/diltiazem 240 mg», target office BP was achieved in 66.67 % of patients, and target BP in ABPM - in 73.34 % of patients. In the group of combination «lercanidipine 10 mg/diltiazem 120 mg», target office BP was achieved in 52.63 % of patients, and target BP in ABPM - in 78.95 % of patients. In the group of combination «lercanidipine 20 mg/diltiazem 120 mg», target office BP was achieved in 82.35 % of patients, and target BP in ABMP - in 52.94 % of patients. Conclusion. Treatment based on both monotherapy and combination of lercanidipin and diltiazem was effective in reducing both office BP and BP in daily monitoring. Due to better tolerability of lercanidipin 20 mg daily and low-dose combination of lercanidipin10 mg and diltiazem 120 mg, these strategies can be recommended for future treatment of patients with mild to moderate AH.