OPTIMAL METHOD OF TREATMENT OF ARTERIAL HYPERTENSION COMBINED WITH DYSPLASIA OF CONNECTIVE TISSUE

Abstract

Arterial hypertension (AН) is one of the most aggressive risk factors for the formation and progression of the pathology of the cardiovascular system (CVS) with lesions of the target organs and the development of associated diseases: coronary heart disease, acute and chronic cerebral pathology, systemic atherosclerosis, lesion of the glomerular kidney system with the development of nephropathy and renal failure.

The aim of the study – to improve the efficiency of treatment of patients with hypertension combined with connective tissue dysplasia (СTD) based on the study of clinical course, the severity of external and internal phenotypic signs of CTD, inflammation activity, blood clotting systems using the combination of ACE inhibitors and CCB using metabolic therapy in a complex treatment.

Material and Methods. We examined 57 patients (24 women and 33 men) at the AH II – III stages with manifestations of СTD. The patients were divided into 3 groups: the group I (main) – 35 patients who, in addition to the baseline therapy, received 2-ethyl-6-methyl-3-hydroxypyridine succinate (мexicor); group II (comparison) – 22 patients who received basic therapy according to the clinical protocol; group ІІІ – 20 practically healthy persons. In the baseline therapy among antihypertensive agents was a combination of ramipril/amlodipine (hartyl-AM) with titration of dose depending on baseline blood pressure levels, daily blood pressure monitoring (DBPM). Patient examination was carried out in accordance with the protocol developed by us: objective review, laboratory tests (coagulogram: prothrombin time (PT), prothrombin index (PI) and total fibrinogen (ТF), determination of C-reactive protein (CRP)), instrumental examination methods (ECG, echocardiography, DMAP, ultrasound examination of the internal organs and vessels of the lower extremities, ultrasound duplex examination of the sleep and vertebral arteries, X-ray examination of the bone and articular system), consultation of an ophthalmologist, a neuropathologist, a traumatologist, a dentist.

Results. As a result of the research conducted in patients with hypertension II–III stage diagnosis of CTD of varying degrees of severity. In the group I of patients with CTD of average severity 30 (85.7 %), in the group II – in 20 (90.9 %), severe severity was observed – in 5 (14.3 %) and 2 (9.1%) patients respectively.

The results of the study showed that up to 10 days of treatment in the main group, the average daily SAT and DAT decreased by 15.6 % and 17.5 % respectively, and up to 30 days – by 25.2 % and 26.4 %. After application of ramipril/amlodipine and 2-ethyl-6-methyl-3-hydroxypyridine succinate in the complex treatment of patients with hypertension associated with CTD, the CRP level decreased by 42.79 % for 10 days of treatment (p<0.01) and 2-fold after 30 days of observation. The level of PI for 10 days has significantly changed – (85.52±4.93) (p <0.05), after 30 days of inpatient treatment – (82.39±5.13) (p <0.05).

Conclusions. The use of ramipril/amlodipine and 2-ethyl-6-methyl-3-hydroxypyridine succinate in the complex treatment of patients with hypertension combined with СТD improves the clinical course of the disease, reduces the incidence of relapses of hypertensive crises, reduces the number of complications, reduces the timing of stabilization of blood pressure, promotes normalization CRP and blood coagulation indexes.