The effectiveness of therapy with valsartan and hydrochlorothiazide and its effect on the left atrial myocardium condition in women with arterial hypertension in postmenopause
Keywords:left atrial deformation, arterial hypertension, postmenopausal women, valsartan, hydrochlorothiazide
Purpose - to evaluate the effectiveness of the combination of valsartan and hydrochlorothiazide and its effect on the structural and functional parameters of the left atrial myocardium in postmenopausal women with arterial hypertension.
Materials and methods. An open prospective controlled study included 100 postmenopausal women with uncomplicated arterial hypertension. Transthoracic and speckle tracking echocardiography was performed on a Vivid E9 XDClear Console 4D Expert 100 ultrasound scanner (General Electric, USA) with ECG-synchronization. Ambulatory blood pressure monitoring was performed using the device ABPM-04 (Meditech, Hungary). After 6 months of treatment with the antihypertensive combination of valsartan and hydrochlorothiazide, all women were re-examined in full. Statistical analysis of the results was performed using the Statistica 13.0 software package. All tests were two-way, statistically significant considered differences at P < 0.05.
Results. As a result of our study, office systolic and office diastolic blood pressure in postmenopausal women with arterial hypertension significantly decreased (P < 0.001) due to a 6-month treatment with valsartan and hydrochlorothiazide. The target level of blood pressure, according to office measurements, was reached by 64 % of patients. A significant decrease of the SBP time index in the daytime in 1.6 times (P = 0.012), morning rise of SBP (P = 0.021) and the average pulse blood pressure (P = 0.012) was observed. Analysis of the LA deformation dynamics under the 6-month antihypertensive therapy did not reveal significant changes in the longitudinal strain of the LA in postmenopausal women with AH, unlike left ventricular strain.
Conclusions. Combined antihypertensive therapy with valsartan and hydrochlorothiazide in postmenopausal women is effective, safe and well-tolerated. The use of this therapy for 6 months does not significantly affect the size and deformation properties of the left atrium, in contrast to the positive structural and functional remodeling of the left ventricle.
Zhdan, V., Kitura, Ye., Kitura, O., Babanina, M., & Tkachenko, M. (2019). Klinichni pidkhody do terapii arterialnoi hipertenzii u zhinok u period postmenopauzy [Clinical approaches to therapy of arterial hypertension in women’s postmenopaceus]. Family medicine, 2, 76-79. doi: 10.30841/2307-5112.2.2019.175177 [in Ukrainian].
Voronkov, L., Amosova, K., Dziak, H., Zharinov, O., Kovalenko, V., & Korkushko, O. et al. (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti [Guidelines of the Ukrainian Association of Cardiologists on the diagnosis and treatment of chronic heart failure]. Heart Failure & Comorbidities, 1 (Add), 6-66. [in Ukrainian].
Voronkov, L. (2012). Patsiient iz KhSN v Ukraini: analiz danykh populiatsii patsiientiv, obstezhenykh u ramkakh pershoho natsionalnoho zrizovoho doslidzhennia UNIVERS [Patient with CHF in Ukraine: analysis of patient population examined in the context of the first national UNIVERS section trial]. Heart failure, 1, 8-13. [in Ukrainian].
Paul, B. (2009). Left atrial volume - a new index in echocardiography. JAPI, 57, 463-465.
Mahabadi, A., Geisel, M., Lehmann, N., Lammerding, C., Kälsch, H., & Bauer, M. et al. (2014). Association of computed tomography-derived left atrial size with major cardiovascular events in the general population: the Heinz Nixdorf Recall Study. International Journal of Cardiology, 174(2), 318-323. doi: 10.1016/j.ijcard.2014.04.068
Yaghi, S., Moon, Y., Mora-McLaughlin, C., Willey, J., Cheung, K., & Di Tullio, M. et al. (2015). Left atrial enlargement and stroke recurrence: the Northern Manhattan stroke study. Stroke, 46(6), 1488-1493. doi: 10.1161/strokeaha.115.008711
de Simone, G., Mancusi, C., Esposito, R., De Luca, N. & Galderisi, M. (2018). Echocardiography in Arterial Hypertension. High Blood Pressure & Cardiovascular Prevention, 25(2), 159-166. doi: 10.1007/s40292-018-0259-y
Kovalenko, V., Lutai, M., Sirenko, Yu., & Sychov, O. (2016). Sertsevo-sudynni zakhvoriuvannia. Klasyfikatsiia, standarty diahnostyky ta likuvannia [Cardiovascular diseases. Classification, diagnosis and treatment standards]. Kyiv. [in Ukrainian].
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., & Böhm, M. et al. (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension, 31(7), 1281-1357. doi: 10.1097/01.hjh.0000431740.32696.cc
Harlow, S., Gass, M., Hall, J., Lobo, R., Maki, P., & Rebar, R. et al. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10. Menopause, 19(4), 387-395. doi: 10.1097/gme.0b013e31824d8f40
Parati, G., Stergiou, G., O’Brien, E., Asmar, R., Beilin, L., & Bilo, G., et al. (2014). European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. Journal of Hypertension, 32(7), 1359-1366. doi: 10.1097/hjh.0000000000000221
Marwick, T., Gillebert, T., Aurigemma, G., Chirinos, J., Derumeaux, G., & Galderisi, M. et al. (2015). Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). European Heart Journal - Cardiovascular Imaging, 16(6), 577-605. doi: 10.1093/ehjci/jev076
Nagueh, S., Smiseth, O., Appleton, C., Byrd, B., Dokainish, H., & Edvardsen, T. et al. (2016). Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal Of The American Society Of Echocardiography, 29(4), 277-314. doi: 10.1016/j.echo.2016.01.011
Kolesnyk, M., & Sokolova, М. (2018). Reliability of two-dimensional speckle tracking echocardiography in assessment of left atrial function in postmenopausal hypertensive women. Zaporozhye medical journal, 20(1), 19-25. doi: 10.14739/2310-1210.2018.1.121875
Thelle, D., & Arnesen, Е. (2010). CRP level as risk marker of cardiovascular disease? Tidsskr. Nor. Laegeforen, 5(130), 512-514. doi: 10.4045/tidsskr.09.1002 [in Norwegian].
Dzjak, G. V., Kolesnik, T. V., & Pogoreckii, Yu. N. (2005). Sutochnoe monitorirovanie arterialnogo davlenija [24-hour blood pressure monitoring]. Kiev. [in Russian].
Annemans, L., Spaepen, E., Gaskin, M., Bonnemaire, M., Malier, V., Gilbert, T., & Nuki, G. (2008). Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Annals Of The Rheumatic Diseases, 67(7), 960-966. doi: 10.1136/ard.2007.076232
Lunder, M., Žiberna, L., Janić, M., Jerin, A., Skitek, M., Šabovič, M., & Drevenšek, G. (2012). Low-dose atorvastatin, losartan, and particularly their combination, provide cardiovascular protection in isolated rat heart and aorta. Heart And Vessels, 28(2), 246-254. doi: 10.1007/s00380-012-0259-0
Katayama, S., Hatano, M., & Issiki, M. (2018). Clinical features and therapeutic perspectives on hypertension in diabetics. Hypertension Research, 41(4), 213-229. doi: 10.1038/s41440-017-0001-5
Sokolova M.V. (2019). Dynamika pokaznykiv deformatsii livoho shlunochka ta markeriv kardialnoho remodeliuvannia ST-2 i kardiotrofinu-1 u zhinok iz hipertonichnoiu khvoroboiu v postmenopauzi pid vplyvom kombinovanoi antyhipertenzyvnoi terapii [Dynamics of left ventricular deformation indicators and markers of cardiac remodeling ST-2 and cardiotrophin-1 in postmenopausal women with arterial hypertension under the influence of combined antihypertensive therapy]. Clinical and experimental pathology, 18(3), 70-77 [in Ukrainian]. doi: 10.24061/1727-4338.XVIII.3.69.2019.274
Dimitroula, H., Damvopoulou, E., Giannakoulas, G., Dalamanga, E., Dimitroulas, T., & Sarafidis, P. A. et al. (2010). Effects of Renin-Angiotensin System Inhibition on Left Atrial Function of Hypertensive Patients: An Echocardiographic Tissue Deformation Imaging Study. American Journal Of Hypertension, 23(5), 556-561. doi: 10.1038/ajh.2010.4
Sardana, M., Syed, A., Hashmath, Z., Phan, T., Koppula, M., & Kewan, U. et al. (2017). Beta‐blocker use is associated with impaired left atrial function in hypertension. Journal Of The American Heart Association, 6(2). doi: 10.1161/jaha.116.005163
Kaminski, M., Steel, K., Jerosch-Herold, M., Khin, M., Tsang, S., Hauser, T., & Kwong, R. (2011). Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertension. Journal Of Cardiovascular Magnetic Resonance, 13(1), 42. doi: 10.1186/1532-429x-13-42
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