Ulyanovsk Medico-biological Journal

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2021-3-36-46

 

COMPARATIVE EFFICACY OF "FIRST STEP" ANTIHYPERTENSIVE DRUG COMBINATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA SYNDROME

O.V. Kotolupova, O.N. Kryuchkova

V.I. Vernadsky Crimean Federal University, Simferopol, Russia

 

Hypertension in combination with obstructive sleep apnea syndrome (OSAS) is a common comorbid pathology that significantly reduces patients’ quality of life and longevity. Blood pressure control in such patients is a serious problem, since there are no clear treatment algorithms due to insufficient evidence base.

The objective of the paper is to compare the efficacy and tolerability of the initial two-drug antihypertensive combinations (perindopril / indapamide and perindopril / amlodipine) as "first step" treatment in patients with a hypertension associated with OSAS.

Materials and Methods. Ninety patients with uncontrolled hypertension stages 1–2 and OSAS were divided into 2 groups. Group 1 patients were treated with perindopril (10 mg) and indapamide (2.5 mg), while Group 2 patients received perindopril (10 mg) and amlodipine (10 mg). Before treatment, the authors examined patients’ complaints and medical history. All the patients underwent general clinical examination, respiratory sleep polygraphy and ABPM. After 4-week treatment, patients with target BP indicators underwent ABPM. The authors examined their new complaints and analyzed office BP.

Results. During treatment, hypertension control was achieved in 34.4 % of patients. The nonresponders to dual therapy (Groups 1 and 2) were patients with moderate and severe OSAS (89.7 % and 90 %, respectively). When analyzing complaints, office blood pressure, and ABPM indicators in patients of both groups who responded to the two-drug therapy, a statistically comparable treatment efficacy was revealed both with perindopril/indapamide and perindopril/amlodipine combinations (p<0.05).

Conclusion. Dual antihypertensive therapy as a “first step” in blood pressure control is not suitable for all patients with a hypertension and OSAS. Consideration should be given to initiating dual therapy in patients with mild OSAS. When comparing the dynamics of complaints, indicators of office blood pressure and ABPM, it was found that the effectiveness of the two studied strategies in responding patients was statistically comparable.

Key words: arterial hypertension, obstructive sleep apnea syndrome, OSAS, antihypertensive therapy, blood pressure.

Conflict of interest. The authors declare no conflict of interest.

 

References

  1. Lombardi Cl., Tobaldini E., Montano N., Losurdo A., Parati G. Obstructive Sleep Apnea Syndrome (OSAS) and Cardiovascular System. Med. Lav. 2017; 108 (4): 276–282.

  2. Gonzaga C., Bertolami A., Bertolami M., Amodeo C., Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J. Hum. Hypertens. 2015; 29 (12): 705–712. DOI: 10.1038/jhh.2015.15.

  3. Arterial'naya gipertenziya u vzroslykh. Klinicheskie rekomendatsii 2020 [Arterial hypertension in adults. Clinical guidelines 2020]. Rossiyskiy kardiologicheskiy zhurnal. 2020; 25 (3): 3786. DOI: 10.15829/1560-4071-2020-3-3786 (in Russian).

  4. Williams B., Mancia G., Spiering W., Rosei E.A., Azizi M., Burnier M., Clement D.L. Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal. 2018; 39 (33): 3021–3104.

  5. Rana D., Torrilus C., Ahmad W., Okam N.A., Fatima T., Jahan N. Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article. Cureus. 2020; 12 (9): 10–42.

  6. Kapur V.K., Auckley D.H., Chowdhuri S. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J. Clin. Sleep. Med. 2017; 13 (3): 479–504.

  7. Mysliwiec V. The management of chronic insomnia disorder and obstructive sleep apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann. Intern. Med. 2020; 172 (5): 325–336.

  8. Malyavin A.G., Babak S.L., Adasheva T.V., Gorbunova M.V., Martynov A.I. Diagnostika i vedenie patsientov s rezistentnoy arterial'noy gipertenziey i obstruktivnym apnoe sna (Klinicheskie rekomendatsii) [Diagnostics and monitoring of patients with resistant arterial hypertension and obstructive sleep apnoea (Clinical guidelines)]. Terapiya. 2018; 1 (19): 4–42 (in Russian).

  9. Ziegler M.G., Milic M., Sun P. Antihypertensive therapy for patients with obstructive sleep apnea. Curr. Opin. Nephrol. Hypertens. 2011; 20: 50–55.

  10. Sukmarova Z.N., Litvin A.Yu., Chazova I.E., Rogoza A.N. Effektivnost' gipertoniey 2–3-y stepeni i tyazheloy stepen'yu sindroma obstruktivnogo apnoe vo vremya sna [Efficacy of combined drug and CPAP therapy in patients with arterial hypertension stages 2-3 and severe obstructive sleep apnea syndrome]. Sistemnye gipertenzii. 2011; 8 (1): 40–43 (in Russian).

  11. Martínez-García M.A., Capote F., Campos-Rodríguez F. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013; 310 (22): 2407–2415.

  12. Guo J., Sun Y., Xue L.J., Huang Z.Y., Wang Y.S., Zhang L., Zhou G.H., Yuan L.X. Effect of CPAP therapy on cardiovascular events and mortality in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath. 2016; 20 (3): 965–974.

  13. James P.A., Oparil S. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311 (5): 507–520.

  14. Nerbass F.B., Pedrosa R.P., Genta P.R. Calcium channel blockers are independently associated with short sleep duration in hypertensive patients with obstructive sleep apnea. J. Hypertens. 2011; 29 (6): 1236–1241.

  15. Ruttanaumpawan P., Nopmaneejumruslers C., Logan A.G. Association between refractory hypertension and obstructive sleep apnea. J. Hypertens. 2009; 27 (7): 1439–1445.

  16. Nerbass F.B., Pedrosa R.P., Genta P.R. Calcium channel blockers are independently associated with short sleep duration in hypertensive patients with obstructive sleep apnea. J. Hypertens. 2011; 29 (6): 1236–1241.

  17. Gorbunov V.M., Fedorova E.Yu., Platonova E.V. Khronoterapiya arterial'noy gipertonii: sovremennoe sostoyanie problem [Chronotherapy of arterial hypertension: Current state of the problem]. Ratsional'naya farmakoterapiya v kardiologii. 2017; 13 (5): 706–715 (in Russian).

  18. Ke X., Sun Y., Yang R., Liang J., Wu S., Hu C., Wang X. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc. Disord. 2017; 17 (1): 287.

  19. Kasai T., Bradley T.D., Friedman O., Logan A.G. Effect of intensified diuretic therapy on overnight rostral fluid shift and obstructive sleep apnoea in patients with uncontrolled hypertension. J. Hypertens. 2014; 32 (3): 673–680.

  20. Ziegler M.G., Milic M., Lu X. Effect of obstructive sleep apnea on the response to hypertension therapy. Clin. Exp. Hypertens. 2017; 39 (5): 409–415.

  21. Ke X., Sun Y., Yang R., Liang J., Wu S., Hu C., Wang X. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc. Disord. 2017; 17 (1): 287–292.

Received July 3, 2021; accepted July 13, 2021.

 

Information about the authors

Kotolupova Ol'ga Viktorovna, Teaching Assistant, Chair of Therapy, Gastroenterology, Cardiology and General Practice (Family Medicine), Medical Academy named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University. 295051, Russia, Republic of Crimea, Simferopol, Lenin Ave., 5/7; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-7051-2349

Kryuchkova Ol'ga Nikolaevna, Doctor od Science (Medicine), Professor, Chair of Therapy, Gastroenterology, Cardiology and General Medical Practice (Family Medicine), Medical Academy named after
S.I. Georgievsky, V.I. Vernadsky Crimean Federal University. 295051, Russia, Republic of Crimea, Simferopol, Lenin Ave., 5/7; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-0350-6843

 

For citation

Kotolupova O.V., Kryuchkova O.N. Sravnitel'naya effektivnost' kombinatsiy antigipertenzivnykh preparatov «pervogo shaga» u patsientov s sochetaniem arterial'noy gipertenzii i sindroma obstruktivnogo apnoe sna [Comparative efficacy of “first step” antihypertensive drug combinations in patients with arterial hypertension and obstructive sleep apnea syndrome]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2021; 3: 36–46. DOI: 10.34014/2227-1848-2021-3-36-46 (in Russian).

 

 

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УДК 616.12-008.331.1:616.8-009.836

DOI 10.34014/2227-1848-2021-3-36-46

 

СРАВНИТЕЛЬНАЯ ЭФФЕКТИВНОСТЬ КОМБИНАЦИЙ АНТИГИПЕРТЕНЗИВНЫХ ПРЕПАРАТОВ «ПЕРВОГО ШАГА» У ПАЦИЕНТОВ С СОЧЕТАНИЕМ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ И СИНДРОМА ОБСТРУКТИВНОГО АПНОЭ СНА

О.В. Котолупова, О.Н. Крючкова

ФГАОУ ВО «Крымский федеральный университет им. В.И. Вернадского», г. Симферополь, Россия

 

Сочетание АГ и синдрома обструктивного апноэ сна (СОАС) является часто встречаемой коморбидной патологией, существенно снижающей качество и продолжительность жизни больных. Контроль АД у таких пациентов – серьезная проблема, так как из-за недостаточной доказательной базы четкие алгоритмы лечения отсутствуют.

Цель. Сравнить эффективность и переносимость стартовых двухкомпонентных антигипертензивных комбинаций «первого шага» (периндоприл/индапамид и периндоприл/амлодипин) у пациентов с сочетанием АГ и СОАС.

Материалы и методы. 90 пациентов с сочетанием неконтролируемой АГ 1–2 стадии и СОАС всех степеней тяжести были разделены на 2 группы. Пациенты группы 1 получали периндоприл 10 мг и индапамид 2,5 мг, а больные группы 2 – периндоприл 10 мг и амлодипин 10 мг. До лечения был проведен сбор жалоб и анамнеза, общеклиническое обследование, респираторная полиграфия сна и СМАД. Через 4 нед. у пациентов, достигших целевых цифр АД, проведен повторный сбор жалоб, измерение офисного АД и СМАД.

Результаты. На фоне лечения контроля АГ удалось достичь 34,4 % пациентам. Не ответившими на двойную терапию в группах 1 и 2 были пациенты со среднетяжелым и тяжелым СОАС (89,7 и 90 % соответственно). При анализе жалоб, офисного АД, показателей СМАД среди ответивших на двухкомпонентную терапию пациентов обеих групп выявлена статистически сопоставимая эффективность лечения как комбинацией периндоприла с индапамидом, так и сочетанием периндоприла с амлодипином (p<0,05).

Выводы. Двойная антигипертензивная терапия в качестве «первого шага» контроля АД подходит не всем пациентам с сочетанием АГ и СОАС. Следует рассмотреть назначение стартовой двойной терапии у пациентов с СОАС 1 степени. При сравнении динамики жалоб, показателей офисного АД и СМАД выявлено, что эффективность применения двух изучаемых стратегий у ответивших пациентов статистически сопоставима.

Ключевые слова: артериальная гипертензия, синдром обструктивного апноэ сна, СОАС, антигипертензивная терапия, артериальное давление.

 

Литература

  1. Lombardi Cl., Tobaldini E., Montano N., Losurdo A., Parati G. Obstructive Sleep Apnea Syndrome (OSAS) and Cardiovascular System. Med. Lav. 2017; 108 (4): 276–282.

  2. Gonzaga C., Bertolami A., Bertolami M., Amodeo C., Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J. Hum. Hypertens. 2015; 29 (12): 705–712. DOI: 10.1038/jhh.2015.15.

  3. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25 (3): 3786. DOI: 10.15829/1560-4071-2020-3-3786.

  4. Williams B., Mancia G., Spiering W., Rosei E.A., Azizi M., Burnier M., Clement D.L. Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal. 2018; 39 (33): 3021–3104.

  5. Rana D., Torrilus C., Ahmad W., Okam N.A., Fatima T., Jahan N. Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article. Cureus. 2020; 12 (9): 10–42.

  6. Kapur V.K., Auckley D.H., Chowdhuri S. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J. Clin. Sleep. Med. 2017; 13 (3): 479–504.

  7. Mysliwiec V. The management of chronic insomnia disorder and obstructive sleep apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann. Intern. Med. 2020; 172 (5): 325–336.

  8. Малявин А.Г., Бабак С.Л., Адашева Т.В., Горбунова М.В., Мартынов А.И. Диагностика и ведение пациентов с резистентной артериальной гипертензией и обструктивным апноэ сна (Клинические рекомендации). Терапия. 2018; 1 (19): 4–42.

  9. Ziegler M.G., Milic M., Sun P. Antihypertensive therapy for patients with obstructive sleep apnea. Curr. Opin. Nephrol. Hypertens. 2011; 20: 50–55.

  10. Сукмарова З.Н., Литвин А.Ю., Чазова И.Е., Рогоза А.Н. Эффективность комплексной медикаментозной и CPAP-терапии у пациентов с артериальной гипертонией 2–3-й степени и тяжелой степенью синдрома обструктивного апноэ во время сна. Системные гипертензии. 2011; 8 (1): 40–43.

  11. Martínez-García M.A., Capote F., Campos-Rodríguez F. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013; 310 (22): 2407–2415.

  12. Guo J., Sun Y., Xue L.J., Huang Z.Y., Wang Y.S., Zhang L., Zhou G.H., Yuan L.X. Effect of CPAP therapy on cardiovascular events and mortality in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath. 2016; 20 (3): 965–974.

  13. James P.A., Oparil S. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311 (5): 507–520.

  14. Nerbass F.B., Pedrosa R.P., Genta P.R. Calcium channel blockers are independently associated with short sleep duration in hypertensive patients with obstructive sleep apnea. J. Hypertens. 2011; 29 (6): 1236–1241.

  15. Ruttanaumpawan P., Nopmaneejumruslers C., Logan A.G. Association between refractory hypertension and obstructive sleep apnea. J. Hypertens. 2009; 27 (7): 1439–1445.

  16. Nerbass F.B., Pedrosa R.P., Genta P.R. Calcium channel blockers are independently associated with short sleep duration in hypertensive patients with obstructive sleep apnea. J. Hypertens. 2011; 29 (6): 1236–1241.

  17. Горбунов В.М., Федорова Е.Ю., Платонова Е.В. Хронотерапия артериальной гипертонии: современное состояние проблемы. Рациональная фармакотерапия в кардиологии. 2017; 13 (5): 706–715.

  18. Ke X., Sun Y., Yang R., Liang J., Wu S., Hu C., Wang X. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc. Disord. 2017; 17 (1): 287.

  19. Kasai T., Bradley T.D., Friedman O., Logan A.G. Effect of intensified diuretic therapy on overnight rostral fluid shift and obstructive sleep apnoea in patients with uncontrolled hypertension. J. Hypertens. 2014; 32 (3): 673–680.

  20. Ziegler M.G., Milic M., Lu X. Effect of obstructive sleep apnea on the response to hypertension therapy. Clin. Exp. Hypertens. 2017; 39 (5): 409–415.

  21. Ke X., Sun Y., Yang R., Liang J., Wu S., Hu C., Wang X. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc. Disord. 2017; 17 (1): 287–292.

Поступила в редакцию 03.07.2021; принята 13.07.2021.

 

Авторский коллектив

Котолупова Ольга Викторовна – ассистент кафедры терапии, гастроэнтерологии, кардиологии и общей врачебной практики (семейной медицины) Медицинской академии им. С.И. Георгиевского, ФГАОУ ВО «Крымский федеральный университет им. В.И. Вернадского». 295051, Россия, Республика Крым, г. Симферополь, б-р Ленина, 5/7; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-7051-2349

Крючкова Ольга Николаевна – доктор медицинских наук, профессор кафедры терапии, гастроэнтерологии, кардиологии и общей врачебной практики (семейной медицины) Медицинской академии им. С.И. Георгиевского, ФГАОУ ВО «Крымский федеральный университет им. В.И. Вернадского». 295051, Республика Крым, г. Симферополь, б-р Ленина, 5/7; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-0350-6843

 

Образец цитирования

Котолупова О.В., Крючкова О.Н. Сравнительная эффективность комбинаций антигипертензивных препаратов «первого шага» у пациентов с сочетанием артериальной гипертензии и синдрома обструктивного апноэ сна. Ульяновский медико-биологический журнал. 2021; 3: 36–46. DOI: 10.34014/2227-1848-2021-3-36-46.