Structural and Functional State of the Left Ventricle in Patients with Essential Hypertension and Rheumatoid Arthritis under the Influence of Various Treatment Regimens

Abstract

Hypertensive disease is one of the most common diseases in the world and the leading cause of death and disability from cardiovascular diseases among the population. Recent studies have indicated that patients with hypertension in combination with rheumatoid arthritis have a higher risk of cardiovascular complications and mortality. Ukrainian recommendations for the management of patients with hypertension for 2018 indicated that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are more effective in regressing left ventricular hypertrophy. The purpose of the study was to compare the effect of long-term therapy with valsartan in combination with indopamide and amlodipine on the structural and functional state of the left ventricular myocardium and the level of blood pressure in patients with arterial hypertension in combination with rheumatoid arthritis. Material and methods. The study included hypertensive patients in combination with rheumatoid arthritis. The patients were divided into 3 groups: the first group consisted of 17 patients with essential hypertension in combination with rheumatoid arthritis who took valsartan at a dose of 80 mg at home. The second group included 17 patients who were transferred to additional administration of the drug indapamide at a dose of 15 mg. The third group consisted of 18 patients whose dose of amlodipine was increased from 5 to 10 mg Results and discussion. In the daily blood pressure profile, the time-averaged values of systolic blood pressure and diastolic blood pressure were calculated for three-time intervals of 24 hours, day and night. Left ventricular remodeling was assessed by the relative left ventricular thickness - the ratio of the sum of the thickness of the interventricular septum and the thickness of the posterior wall to the final diastolic size of the left ventricular. The norms were considered to be an indicator of relative wall thickness <0.45. When studying the analysis of the effect of 4-week monotherapy of valsartan at a dose of 80 mg / day on the level of blood pressure and daily blood pressure profile, we revealed a statistically significant decrease in blood pressure by -14.1±2.2 / -8.2±1.4 mm Hg. Art. (P <0.01), mean daily values of systolic blood pressure (24) by 15.1±2.4 mm Hg. Art. (P <0.001), diastolic blood pressure (24) on September 8±1.7 mm Hg. Art. (P <0.001), day and night mean values and indicators of systolic blood pressure and diastolic blood pressure. Analysis of 24-week monotherapy with amlodipine (the average dose of which was 10 mg / day) in 15 patients revealed a decrease in blood pressure by 24.1±3.6 / 15.2±2.3 mm Hg. Art. (P <0.01) and its normalization in 9 out of 15 patients (60%). According to the ABPM data, a significant decrease in systolic blood pressure and diastolic blood pressure was revealed within 24 hours, both in the daytime and at night. The target level of 24-hour AO was achieved in 6 (40%) patients. Valsartan therapy and their combination with indapamide led to regression of left ventricular hypertrophy in all patients, normalization of left ventricular geometry in 33% of patients. In 24 patients with concentric left ventricular hypertrophy, in (25%) left ventricular myocardial mass index and left ventricular geometry normalized, in 4 (17%) patients, left ventricular hypertrophy became eccentric, in 1 (4%) it turned into concentric remodeling, in 10 (54%) patients it remained without changes. Conclusion. Therefore, valsartan and its combination with indapamide in these patients led to regression of left ventricular hypertrophy, normalization of left ventricular geometry in 33% of patients, improvement of left ventricular diastolic function in 88.2%