Prognostic value of systolic blood pressure increase and its correction in Ukrainian patients with arterial hypertension: the results of cohort study СИСТЕМА-2 (Systema-2)
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Abstract
The aim – to assess the effect of the systolic blood pressure lowering (SBP) on the decreasing of cardiovascular and cardiocerebral complications in 3 and 12 months after the therapy change in patients aged over 55 years without blood pressure control at the routine GP management.
Materials and methods. 102 physicians from various regions of Ukraine took part in СИСТЕМА-2 (Systema-2) study. The study consistently involved patients over the age of 55 who had applied to a GP with an arterial hypertension (a total of 2,040 patients).
Results and discussion. Among patients who took antihypertensive drugs (91.6 %), the mean SBP was 167 mm Hg, and the blood pressure target level was observed only in 6.9 % of the cases. After 3 months of treatment mean SBP was 138.0±1.0 mm Hg in group with the combination of indapamide with amlodipine and in group with other antihypertensive treatment – 151.0±4.8 mm Hg. After the one year of observation the most of patients reached the target level of SBP – mean SBP in patients taking the combination of indapamide with amlodipine was 132.0±0.5 mm Hg and other antihypertensive therapy – 136.0±1.4 mm Hg (42 % of patients took 3 and more antihypertensive medicines) (p=0,01). The unfavorable course of hypertension was not associated with the initial level of SBP, but the with level of SBP after 3 months of treatment. The number of non-fatal stroke in the group of patients taking the combination of indapamide with amlodipine was 0.4 %, in the group with other treatment was 1.9 %. Within a year 38 (2 %) patients died. The leading cause of death was cardiovascular diseases – 21 (55 %) patients.
Conclusions. Reduction of SBP was significantly higher in the group of patients taking the combination of amlodipine and indapamide after 3 and 12 months. The factor associated with a decrease in the incidence of stroke is the early achievement of the target level of SBP, as evidenced by statistically significant differences in this indicator in patients with stroke and in patients without this complication 3 months after their involvement in the study. The use of the recommended combination therapy for calcium antagonist and diuretic in patients aged over 55 years provides better control of blood pressure and statistically significant decreases in the number of strokes, even in the presence of other factors of an adverse prognosis. Low attachment and withdrawal therapy are associated with a significant deterioration in the prognosis.
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References
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