1Yerevan State Medical University-Department of Internal Medicine2,RMC Armenia Department of Cardiology, Yerevan, Armenia
2Republican Medical Center Armenia, Yerevan, Armenia
3Yerevan State Medical University- Department of Internal Medicine, Yerevan, Armenia
4Yerevan State Medical University, Yerevan, Armenia
Aim: The aim of clinical study was an estimation of change of heart rate variability and arterial pressure at elderly patients with isolated systolic hypertension, who have received amlodipine separately and in a combination with perindopril(prestarium):prestans10/5.
Materials and Methods: In the study we have included 34 elderly patients with isolated systolic hypertension(20 male, 14 female, mean age 70,0 ± 5,0).LVEF of all patients was more than 40%.Starting systolic blood pressure (SBP) -175 ± 9,0 mm Hg, diastolic blood pressure (DBP)-60,5 ± 8,8 mm Hg.All patients during 8 weeks were receiving amlodipine 5 mg per day. After 4 weeks of treatment we have changed amlodipine to prestans 10/5(10 mg perindopril, 5 mg amlodipine)per day.The activity of the autonomic nervous system was estimated by using spectral and statistical analyses of RR- intervalogramms. RR-intervals were registered during 5 min. at the rest.Spectral parameters of the heart rate variability were: low frequency component(LF)-0,15- 0,4 Hz and their ratio (LF/HF). Time parameters were: SDNN, SDANN, rMSSD, pNN50. All parameters were measured at the beginning of the study and after 8 weeks of treatment with prestans.
Results: After 4-week treatment with amlodipine antihypertensive effect was registered at 28 patients:control AP(SBP<140) at 23 patients,AP normalization (SBP<125) at 5 patients.During that period were not registered any changes of spectral and time parameters of heart rate variability.After 4-week treatment with prestans 10/5 the normalization of AP was registered at 24 patients.After adding prestans to the treatment were registered changes of heart rate variability parameters:ranges of parasympathetic nervous system were increased(SDNN,rMSSD,pNN50(p < 0,001);HF(p-0,05),the LF/HF ratio was decreased(p < 0,01).
Conclusion: The therapy with prestans 10/5(10 mg perindopril+ 5 mg amlodipine) in comparison with mono therapy with amlodipine favorably influences on automatic nervous system by means of suppression of sympathetic hyperactivity.Moreover,the therapy with prestans 10/5 leads to significant arterial pressure decrease.