Clinic: Modern approaches to diagnostics and treatment of arterial hypertension” (final part)

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The final third part of the article.
In such a situation today, we must remember that there are medical interventions, which is at an early stage can help, in particular, the famous study STOP-NIDDM showed that the appointment of acarbose in patients with impaired glucose tolerance before diabetes, 25% slows the rate of development of diabetes and in parallel by 27 % reduces the risk of cardiovascular complications (heart attack, stroke, death), that is, gives a great effect. The focus for the prevention of cardiovascular complications of diabetes today is not on drugs that stimulate the pancreas, especially to prevent complications, namely insulinsensitizing, drugs that increase tissue sensitivity to insulin.

The famous UKPDS study shows that Metformin has advantages over insulin, sulfadoxine and diet in preventing cardiovascular complications have already developed diabetes.

Another Russian study, which was conducted under the leadership of Yu. N. References: I. E. Chasovoy. This program is on the application of Quinapril* patients with hypertension with risk factors, especially obesity and metabolic syndrome. Have demonstrated the effectiveness of Akkupro compared to other drugs that were used for comparison. Systolic BP was reduced by 27 mmHg, diastolic pressure of 14 mmHg, and 74% of patients receiving Akkupro, reach target BP versus 46% in the control group.

Many of our colleagues there is an opinion that patients with obesity make better use of the ACE inhibitor lisinopril, supposedly he is not fat soluble, therefore is effective in patients with excessive body mass. However, fat cells are active, secrete hormones and cytokines, leading to endothelial dysfunction and development of atherosclerosis. Lisinopril does not fall into the fatty tissue, and it is just useless to treat the patient with obesity, metabolic syndrome. In addition, the study АLLНАТ it has been shown that lisinopril is bad and for the treatment of elderly patients with hypertension and impaired renal function. The antithesis of lisinopril is penetrating the fabric the drug Akkupro, which has shown the ability to normalize the HELL is 28% more than other antihypertensive drugs.

But the main problem is that risk factors are summarized, and the risk of morbidity and mortality in this growing exponentially. Very few of the people who smoke who have only diabetes or dyslipidemia. And Smoking, diabetes, dyslipidemia, and hypertension increase the risk of not more than 3 times, and if three of these factors (Smoking plus diabetes plus hypertension), the risk of cardiovascular complications immediately increased 15 times, and if you add obesity, the risk increases already in 65 times. Here’s the main problem. And 4 main risk factors — Smoking, hypertension, diabetes, dyslipidemia — lead to 75 % of the deaths, so you need to remember that risk factors are combined, and we have a complex influence on them.

Basically, in order to protect vessels from changes, and the patient against the development of atherosclerosis and its complications (death, heart attack and stroke), requires:

  • Smoking cessation and physical activity mandatory;
  • Mediterranean diet;
  • aggressive treatment of dyslipidemia, timely, with the appointment effective statin (atorvastatin) without waiting for the transferred heart attack and complications;
  • combined treatment of hypertension according to modern principles — the ACE inhibitors are the leaders in this list;
  • treatment of hyperglycemia and insulin resistance with attention to drugs that affect insulin resistance. This is by far the Metformin, acarbose and thiazolidinediones.

And of course you need to remember that reducing the risk of thrombosis, the use of small doses of aspirin in high-risk patients in primary prevention can be extremely useful.

It is crucial to understand that you come to the patient, who had neither a heart attack nor a stroke, had no terrible complications, but there are risk factors, potentially tomorrow or the day after these complications to. And if the specialist in advance of these risk factors will begin to heal, it is possible to avoid the occurrence of these complications.

Thus, based on the above, we can make the following conclusions:

1) Treatment of hypertension in ambulatory patients should be carefully considered by a doctor to be comprehensive. In forming the scheme of treatment should be identified and taken into account the available patient risk factors.

2) There is a close relationship between the value of increasing blood pressure and risk of cardiovascular complications in a specific patient.

3) it is understood that, formally treated but inadequately controlled hypertension has serious consequences, causing and accelerating the development of cardiovascular, cerebral and renal complications.

4) Achievement of target blood pressure levels is still considered as a paramount condition for the successful treatment of patients with arterial hypertension, especially in patients with diabetes.

5) Which of the antihypertensive drugs utilized, by using monotherapy effectively control blood pressure can only have a limited number of patients, most of which require the administration of a combination of at least two antihypertensive drugs.

6) In antihypertensive therapy in the modern treatment standards must include tools that affect the level of cholesterol in the blood, the so-called statins, and drugs with direct antioxidant and antihypoxant action, in particular, Mexidol (Maximin).

I wish You success in the treatment of hypertension!

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