Effectiveness of three-component antihypertensive therapy in obese patients with arterial hypertension
Aim of the study: evaluation of antihypertensive, organoprotective effectiveness and influence of triple combination antihypertensive therapy with valsartan, indapamide and amlodipine on metabolic disorders in obese hypertensive patients, who are resistant to two-component therapy. Materials and methods: The study included 66 men with hypertension of the average age 56.06±7.86 years, abdominal obesity (waist circumference is 103.11±6.4 cm and body mass index is 34.54±3.83 kg/m2) that were resistant to two-component antihypertensive therapy. Hypertensive patients with associated clinical conditions were not included into the study. Target organ damage (TOD) was diagnosed with echocardiography and ultrasound of brachiocephalic arteries. Microalbuminuria was determined in daily urine; glomerular filtration rate was calculated using the EPI formula. Lipids and glucose levels, serum creatinine and uric acid were measured with the help of biochemical methods. All measurements were conducted before and during 6-month therapy with valsartan, indapamide and amlodipine in average daily doses 135.65±37.63 / 2.52±1.4 / 7.5±2.6 mg, respectively.Results. According to AH degree and the revealed risk factors and TOD, obese patients with hypertension were characterized by high cardiovascular risk. Triple combination therapy showed high antihypertensive effectiveness with achievement of target blood pressure in 94% of patients, decrease of systolic BP by 22.26±5.84% and diastolic BP by 21.1±5.85%, significant decrease of pulse BP. Heart rate did not change. Valsartan, indapamide and amlodipine combination is characterized by significantly high cardioprotective, renoprotective effectiveness and metabolic neutrality. Additional non-pharmacological interference promoted reduction of the thickness of epicardial fat and waist circumference, and influenced dyslipidemia positively. Conclusion. Six-month triple combination antihypertensive therapy with valsartan, indapamide and amlodipine promoted achievement of the target level of blood pressure in 94% of obese hypertensive patients, who were resistant to two-component therapy, with significant target organ protection and positive influence on metabolic disorders.