К.М. Amosova, Yu.V. Rudenko. The unified algorithm of antihypertensive therapy and home blood pressure control in patients with apparent treatment-resistant arterial hypertension in outpatient practice

The aim – to determine the efficiency of a unified simplified step-by-step algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with apparent treatment-resistant hypertension (aTRH) and improving their adherence to treatment in general cardiology outpatient practice. Materials and methods. An open-label prospective study involved 407 patients with uncomplicated uncontrolled essential arterial hypertension (AH) who received antihypertensive therapy at least for a month before the study. Among these, 122 (30 %) patients were initially scheduled ≥ 3 drugs (first group of patients with aTRH, 285 (70 %) patients were initially scheduled ≤ 2 drug (second group). During the first visit, the physician determined ABP; the patients were provided with automatic oscillometric devices. A fixed combination of perindopril and amlodipine was prescribed at dosages 5/5, 5/10, 10/5 or 10/10 mg at the physician’s discretion (Step 1). During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of perindopril/amlodipine to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard 1.5 mg once daily (Step 3), spironolactone 50 mg daily (Step 4), moxonidine 0.2 – 0.6 mg or doxazosin 4–8 mg daily (Step 5). Adherence to treatment was evaluated during the first and final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure (BP) < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change of adherence to the treatment. Results and discussion. Patients in both groups were comparable by demographic and most clinical parameters. After 6 months of the treatment, mean systolic office BP (M±SD) in the study groups decreased from (166.1±14.6) to (132.8±9.4) mmHg and from (165.9±15.0) to (131.2±9.7) mmHg, diastolic BP – from (97.7±10.6) to (79.3±7.3) mmHg and from (95.0±9.9) to (79.8±7.0) mmHg, respectively, (all Р<0.0001). Target office BP was achieved in 73,1 and 80 % patients, respectively, which was accompanied by normal home BP – in 62,1 and 63.1 % cases, respectively (all Р>0.05). The usage of ≥ 3 drugs was needed in 45.4 and 29.2 % patients, maximum dose of perindopril/amlodipine – in 55.6 and 38.1 % of patients, respectively (Р<0.01). The proportion of patients with high and moderate adherence to treatment increased from 44.9 and 48.4 % to 88 and 94.2 %, respectively (Р<0.001). Conclusions. The 6-months use of step-by-step treatment algorithm and home blood pressure control allowed to achieve target level of office BP with comparable frequency (73.1 and 80 %) in patients with apparent treatment-resistant hypertension and those who were initially assigned ≤ 2 drugs. Home BP decreased to < 135/85 mmHg in 62.1 and 63.1 % cases, respectively and was associated with high and moderate adherence to treatment in 88 and 94.2 % of patients. To achieve therapeutic goals patients with apparent treatment-resistant hypertension in comparison to those with similar levels of BP who were initially assigned ≤ 2 drugs, required use of 3 or more antihypertensive drugs by 16.3 % more, and maximum dose of the fixed combination of perindopril/amlodipine – by 17.6 % more.

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