VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN RURAL MALES WITH ARTERIAL HYPERTENSION: THE POSSIBILITIES OF MODIFYING IN REAL CLINICAL SETTINGS
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Keywords

blood pressure, visit-to-visit variability, arterial hypertension.

How to Cite

Nimtsovych, T., MikhalievК., Kravchenko, A., Gurianov, V., Chursina, T., Mishcheniuk, O., & Stanislavska, S. (2020). VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN RURAL MALES WITH ARTERIAL HYPERTENSION: THE POSSIBILITIES OF MODIFYING IN REAL CLINICAL SETTINGS. Clinical and Preventive Medicine, (3), 62-76. https://doi.org/10.31612/2616-4868.3(13).2020.08

Abstract

Purpose: to establish the possibilities of modifying blood pressure visit-to-visit variability (VVV) in rural males with arterial hypertension (HTN) by the use of antihypertensive therapy (AHT), considering also the correction of dyslipidemia and certain lifestyle aspects, as well as the changes in compliance with pharmacotherapy (CP).

Material and methods. The prospective study enrolled 160 rural males with uncomplicated primary HTN (mean age 50 ± 6 years). Seventy three (45,6 %) patients were overweight; 85 (53,1 %) patients were active smokers. An alcohol consumption ≥1 time per week was pointed out by 77 (48,1 %) males. VVV (of systolic (SBP) and diastolic blood pressure (DBP)) was assessed by means of standard deviation (SD) and coefficient of variation (CV). We prescribed a fixed perindopril/amlodipine (P/A) combination, with indapamide (IND) addition as required. With the aim dyslipidemia correction, we prescribed atorvastatin (daily doses 10-40 mg). Optimal CP was pointed out by 37 (23,1 %) patients.

Results. At 1yFU, all enrolled patients achieved SBP/DBP targets (<140/90 mm Hg), and strict SBP/DBP targets (<130/80 мм Hg) were achieved in 159 (99,4 %) cases. More than 90 % of patients achieved the following prespecified «target» BP VVV levels: SD (SBP) <4,8 mm Hg; CV (SBP) <3,9 %; SD (DBP) <3,7 mm Hg; CV (DBP) <5,1 %. Aimed to predict SD (SBP) reduce >9,7 mm Hg probability at 1yFU, we built the 6-factors logistic regression model: 1) improvement and maintenance of optimal CP (by MGLS) (β = 1,27; р<0,001); 2) body mass index reduce >1,3 kg/m2 (β = 0,57; p=0,035); 3) alcohol consumption modifying (0,72; p=0,007); 4) optimal compliance with atorvastatin daily doses 30-40 mg (1,25; p<0,001); 5) smoking status modifying (0,43; р=0,097); 6) SBP reduce >46,7 mm Hg (0,47; р=0,098). The probability of status «reduction of SD (SBP) >9,7 mm Hg at 1yFU» increase was associated with the higher sum of predictors` β-coefficients.

Conclusions. In rural HTN males, at 1yFU, the AHT (based on P/A, with IND addition as required) favored the significant blood pressure VVV reduction in the vast majority of cases. The SBP VVV reduction was determined to be additively affected by the modifying of certain factors, as well as by achievement and maintenance of maximum CP.

https://doi.org/10.31612/2616-4868.3(13).2020.08
ARTICLE PDF (Українська)
SUPPLEMENTARY MATERIALS (Українська)

References

Unger, T., Borghi, C., Charchar, F., Khan, N., Poulter, N., & Prabhakaran, D. et al. (2020). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6), 1334-1357. https://doi.org/10.1161/hypertensionaha.120.15026.

Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., & Burnier, M. et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021-3104. https://doi.org/10.1093/eurheartj/ehy339.

Svishchenko, I., Bagrii, A., Iena, L., Kovalenko, V., Koval, S., & Mellina, I. et al. (2008) Rekomendatsii Ukrainskoi Asotsiatsii kardiolohiv z profilaktyky ta likuvannia arterialnoii hipertenzii [Guidelines of Ukrainian Society of Cardiology on prevention and treatment of arterial hypertension]. Kyiv: PP VMB, 80 [In Ukrainian].

Harrington, R., Califf, R., Balamurugan, A., Brown, N., Benjamin, R., & Braund, W. et al. (2020). Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. Circulation, 141(10). doi: 10.1161/cir.0000000000000753.

Parati, G., Ochoa, J., Lombardi, C., & Bilo, G. (2013). Assessment and management of blood-pressure variability. Nature Reviews Cardiology, 10(3), 143-155. https://doi.org/10.1038/nrcardio.2013.1.

Nardin, C., Rattazzi, M., & Pauletto, P. (2019). Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases. High Blood Pressure & Cardiovascular Prevention, 26(5), 353-359. https://doi.org/10.1007/s40292-019-00339-z.

Diaz, K., Tanner, R., Falzon, L., Levitan, E., Reynolds, K., Shimbo, D., & Muntner, P. (2014). Visit-to-Visit Variability of Blood Pressure and Cardiovascular Disease and All-Cause Mortality. Hypertension, 64(5), 965-982. doi: 10.1161/hypertensionaha.114.03903.

Webb, A., Fischer, U., Mehta, Z., & Rothwell, P. (2010). Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. The Lancet, 375(9718), 906-915. https://doi.org/10.1016/s0140-6736(10)60235-8.

Webb, A., & Rothwell, P. (2011). Effect of Dose and Combination of Antihypertensives on Interindividual Blood Pressure Variability. Stroke, 42(10), 2860-2865. https://doi.org/10.1161/strokeaha.110.611566.

Rothwell, P., Howard, S., Dolan, E., O'Brien, E., Dobson, J., & Dahlöf, B. et al. (2010). Effects of β blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. The Lancet Neurology, 9(5), 469-480. https://doi.org/10.1016/s1474-4422(10)70066-1.

Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., & Böhm, M. et al. (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal Of Hypertension, 31(7), 1281-1357. https://doi.org/10.1097/01.hjh.0000431740.32696.cc.

Shirley, M., & McCormack, P. (2015). Perindopril/Amlodipine (Prestalia®): A Review in Hypertension. American Journal Of Cardiovascular Drugs, 15(5), 363-370. https://doi.org/10.1007/s40256-015-0144-1.

Mazza, A., Lenti, S., Schiavon, L., Sacco, A. P., Dell’Avvocata, F., Rigatelli, G., & Ramazzina, E. (2017). Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice. Advances in Therapy, 34(4), 975–985. https://doi.org/10.1007/s12325-017-0511-1.

Catapano, A., Graham, I., De Backer, G., Wiklund, O., Chapman, M., & Drexel, H. et al. (2016). 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart Journal, 37(39), 2999-3058. https://doi.org/10.1093/eurheartj/ehw272.

Diaz, K., Muntner, P., Levitan, E., Brown, M., Babbitt, D., & Shimbo, D. (2014). The effects of weight loss and salt reduction on visit-to-visit blood pressure variability. Journal Of Hypertension, 32(4), 840-848. https://doi.org/10.1097/hjh.0000000000000080.

Ishida, T., Miura, S., Fujimi, K., Ueda, T., Ueda, Y., & Matsuda, T. et al. (2016). Visit-to-Visit Variability and Reduction in Blood Pressure After a 3-Month Cardiac Rehabilitation Program in Patients With Cardiovascular Disease. International Heart Journal, 57(5), 607-614. https://doi.org/10.1536/ihj.16-026.

Maseli, A., Aeschbacher, S., Schoen, T., Fischer, A., Jung, M., & Risch, M. et al. (2017). Healthy Lifestyle and Blood Pressure Variability in Young Adults. American Journal Of Hypertension, 30(7), 690-699. https://doi.org/10.1093/ajh/hpx034.

Nimtsovych, T., Kravchenko, A., Mishcheniuk, O., Mikhaliev, К., & Chursina, T. (2020). Mizhvizytna variabelnist arterialnoho tysku u cholovikiv z arterialnoiu hipertenziieiu, shcho prozhyvaiut u silskii mistsevosti: zviazok z fibryliatsiieiu peredserd neklapannoho genezu [Visit-To-Visit Blood Pressure Variability In Rural Males With Arterial Hypertension: Association With Non-Valvular Atrial Fibrillation]. Clinical and Preventive Medicine, 2(12), 90–109. https://doi.org/10.31612/2616-4868.2(12).2020.06. [In Ukrainian].

Pasyechko, N., Radetska, L., Yarema, N., Bob, A., Smatchylo, I., & Homitska, A. (2019). Komplaiens do likuvannia khvorykh z arterialnoiu hipertenziieiu ta ishemichnoiu khvoroboiu sertsia v ambulatornykh umovakh [Compliance for the treatment of patients with arterial hypertension and coronary heart disease in outpatient care]. Achievements of Clinical and Experimental Medicine, (1), 112-116. https://doi.org/10.11603/1811-2471.2019.v0.i1.10059.

Rogoza, A., Agaltsov, M., Sergeeva, M. (2005). Sutochnoe monitorirovanie arterialnogo davleniya: variantyi vrachebnyih zaklyucheniy i kommentarii [24-Hour blood pressure monitoring: medical opinions and comments]. Nizhniy Novgorod: DEKOM, 63 [In Russian].

Mitchenko, O. (2019). Novi rekomendatsii z diahnostyky ta likuvannia dyslipidemii (ESC/EAS, 2019) ta yikh implementatsiia v Ukraini [New guidelines for the management of dyslipidaemias (ESC/EAS, 2019) and their implementation in Ukraine]. Retrieved 12 July 2020, from http://www.athero.org.ua/JQuery-Slider%20UAS/indexpict.html. [In Ukrainian].

Parati, G., Ochoa, J., Lombardi, C., & Bilo, G. (2015). Blood Pressure Variability: Assessment, Predictive Value, and Potential as a Therapeutic Target. Current Hypertension Reports, 17(4). https://doi.org/10.1007/s11906-015-0537-1.

Kollias, A., Stergiou, G., Kyriakoulis, K., Bilo, G., & Parati, G. (2017). Treating Visit-to-Visit Blood Pressure Variability to Improve Prognosis. Hypertension, 70(5), 862-866. https://doi.org/10.1161/hypertensionaha.117.10087.

Gupta, A., Mackay, J., Whitehouse, A., Godec, T., Collier, T., & Pocock, S. et al. (2018). Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial. The Lancet, 392(10153), 1127-1137. https://doi.org/10.1016/s0140-6736(18)31776-8.

Elliott, W., & Bistrika, E. (2017). Perindopril arginine and amlodipine besylate for hypertension: a safety evaluation. Expert Opinion On Drug Safety, 17(2), 207-216. https://doi.org/10.1080/14740338.2018.1397129.

Newman, C., Preiss, D., Tobert, J., Jacobson, T., Page, R., & Goldstein, L. et al. (2019). Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arteriosclerosis, Thrombosis, And Vascular Biology, 39(2). https://doi.org/10.1161/atv.0000000000000073.

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