Cardioprotective and Metabolic Effects of Antihypertensive Therapy in Patients With Such Comorbidities as Arterial Hypertension, Type 2 Diabetes Mellitus, and Obesity

Abstract

Connection of the publication with planned research works.The work is a fragment of the research project "To determine the features of immunocytokine imbalance in comorbid patients with arterial hypertension and type 2 diabetes and cardiovascular and renal complications", state registration № 0123U101711. Introduction.Presently, the world is facing high rates of occurrence of such chronic diseases as arterial hypertension (AH), type 2 diabetes mellitus (T2DM), and obesity (OB). The combination of AH and T2DM multiplies the risk of developing life-threatening cardiovascular complications tenfold [1][2][3][4]. A decrease in systolic blood pressure (BP) by every 10 mmHg has been proven to reduce mortality by 15% according to the UKPDS study (1998) [5].The most up-to-date treatment concept in comorbid patients is an individual approach, which accounts for the presence of complications or the risk of complications with appropriate differentiated tactics [6][7][8][9]. Thus, the first step in treating patients at high risk of developing vascular complications involves normalizing blood pressure. Present-day tactics include antihypertensive therapies that are effective for a particular patient and do not cause side effects [10][11][12]. As for patients with moderate vascular risk, it is appropriate to use medications with metabolic neutrality, namely angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) [13,14].Patients with a slight increase in blood pressure, who are expected to normalize it with monotherapy, are recommended to start with ARB. Moreover, it is worth emphasizing that these medications should be used as part of combination therapy, as their nephroprotective effect has been well documented [15,16].Currently, antihypertensive agents that inhibit excessive activation of the renin-angiotensin-aldosterone system (RAAS), in particular ACEIs and ARBs, are the most expedient and reasonable for the complex treatment