COMPREHENSIVE TREATMENT OF ARTERIAL HYPERTENSION COMBINED WITH ISCHEMIC DISEASE AND HEART RHYTHM DISORDERS
DOI:
https://doi.org/10.11603/1811-2471.2019.v0.i1.10072Keywords:
arterial hypertension, coronary heart disease, cardiac arrhythmias, fructose-1,6-diphosphateAbstract
In the complex treatment of hypertension in combination with chronic coronary artery disease, it is most appropriate to use means that have a beneficial effect on the course of both diseases: to lower the level of blood pressure, to prevent ischemia and angina, myocardial infarction and stroke, to reduce the likelihood of death, to improve the quality of life of patients. But the treatment of comorbid patients with hypertension, coronary artery disease, and cardiac arrhythmias in the background of hypophosphatemia is currently not completely determined.
The aim of the study – the clinical efficacy of complex treatment in patients with hypertension in combination with coronary heart disease and cardiac rhythm disorders in the background of hypophosphatemia.
Material and Methods. The analysis of treatment of 353 patients aged (71.2±4.5) years with hypertension and coronary heart disease, received baseline therapy. Among them, 97 (50 women and 47 men) patients with hypertension, coronary heart disease, heart rhythm disorders and hypophosphataemia maintained an unstable course of hypertension and cardio-pain attacks. The main group included 48 patients (25 women and 23 men) who received a fixed combination of bisoprolol fumarate (5 mg) with amlodipine (5 mg) and fructose-1,6-diphosphate. The comparison group included 49 patients (24 women and 25 men), whose D-fructose-1,6-diphosphate was not added to the treatment complex. A general-clinical examination, blood electrolytes, electrocardiography (ECG), daily ECG monitoring and blood pressure (BP) were performed. Hypophosphatemia was diagnosed at serum phosphorus level <0.9 mmol/l.
Results. After treatment, the number of angina attacks was recorded 2.25 times (1.07±0.03) versus (2.41±1.05) less frequently, depression events of the ST segment were significantly lower (2.13 versus 4.2) in patients with the main group, compared with those in the comparison group. The achievement of the target level of systolic blood pressure was noted in 69.2 % of the patients in the main group and 65.4 % in the comparison group (p <0.05 among the groups). Atrial fibrillation was diagnosed in 4 (8.3 %) patients in the primary and 7 (14.2 %) in the comparison group. Supraventricular extrasystole was recorded in 8 (16.6 %) patients in the primary and in 10 (20.4 %) patients in the comparison group. Ventricular arrhythmias – in 3 (6.25 %) patients of the primary and 10 (20.4 %) of the comparison group. Dangerous ventricular rhythm disturbances after treatment in the main group have not been registered in any case.
Conclusions. The application of complex therapy for patients with arterial hypertension in combination with ischemic disease, heart rhythm disturbances and hypophosphatemia with inclusion in the treatment complex D-fructose-1,6-diphosphate provides a significant anti-ischemic effect, which leads to a decrease (in 2.25 times) of the frequency of angina attacks, reduction of supraventricular extrasystoles, paroxysms of atrial fibrillation, absence of ventricular rhythm dangerous for life.
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