Secondary Logo

Journal Logo

doi: 10.1097/01.hjh.0000378818.08207.86

Problem Urgency: According to last recommendations the combined therapy is preferred in treatment of arterial hypertension(AH).Despite efficiency of monotherapy withβ-adrenoblockers (β-AB) and inhibitors of angiotensin transforming enzymes (IHTE),their combination is considered irrational. However, necessity of such combination is obvious in patients with AH combined with ischemic heart disease (IHD),especially with occurrence of heart failure (HF).

Objective: To study efficiency of combination of β-AB with IHTE during a long-term antihypertensive therapy (AT)for 10–20 years in patients with AH combined with IHD.

Design and Methods: 57 men of 30–59 years (on average 52,5 ± 1,3), suffering AH in combination with IHD were examined. All examined patients underwent AHT in combination of bisoprolol (concor 5–10 mg/day) and perindopril (4–8 or 5–10 mg/day) or nebivalol (5–10 mg/day) with kvinalapril (accupra 10–20 mg/day). There was observed HF in 24 patients who had cardiac infarction, and in 33–tension stenocardia. All patients underwent electrocardiography examination (ECG), monthly measurement of arterial tension (AT) and pulse during the treatment. Compliance to treatment and quality of life (QL) were also studied.AHT was appointed after 2–4 weeks of placebo period and randomization by five stratification criteria. Average duration of treatment was 12,8 ± 1,2 years.

Results: During the whole period of treatment in all patients there were observed resistant and expressed antihypertensive effect: reliable fall of systolic and diastolic AH in comparison with placebo period. In the group of patients received bisoprolol + perindopril,AT went down to 128,4 ± 2,8 (SAT) and 92,6 ± 1,3 (DAT)mm Hg in comparison with placebo period when AH was 166,8 ± 3,2 mm Hg and 108,8 ± 2,1 mm Hg (p < 0,01).

In patients receiving a nebivalol + accupra combination,AH went down much: SAH = 118,8 ± 1,9 and DAH = 88,5 ± 2,7 mm Hg (p < 0,01).Alongside with satisfactory antihypertensive effect of this combination there were observed good endurance,low frequency of side effects, high compliance to treatment and improvement of QL,on a background of nebivalol and kvinalapril.

Conclusions: A long AHT with a combination of β-AB + IHTE in patients with AT is effective and safe enough and especially preferable during accompanying IHD, in particular, heart failure and tension stenocardia.

The Azerbaijan State Institute of Postgraduate Education of Physicians named after A.Aliyev, Baku, Azerbaijan

© 2010 Lippincott Williams & Wilkins, Inc.