Intensification of antihypertensive therapy in patients with uncontrolled arterial hypertension and overweight/obesity based on results of Ukrainian study SATISFACTION
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Abstract
The aim – to define the profile of patients with the arterial hypertension (AH) and overweight (body mass index (BMI): 25–29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2) who do not achieve office blood pressure (BP) < 140/90 mm Hg with the antihypertensive therapy.
Materials and methods. One hundred eighty five (185) general practitioners/primary care doctors consecutively, at the visits enrolled 1798 patients with AH, office BP > 140/90 mm Hg and overweight/obesity into the multicenter, open-label, observational, epidemiological study. The patients were surveyed using the standard questionnaire, they had the general clinical examination, their BMI and waist circumference (WC) were measured, they received recommendations regarding the physical activity and nutrition and their antihypertensive therapy was adjusted at the doctor discretion. After 1 month, at Visit 2, BP was monitored, efficacy of the prescribed therapy was evaluated and changes of body weight, BMI, WC and compliance were assessed. After another 1 month, Visit 3 was conducted by telephone.
Results and discussion. Mean age of patients was 59,06±11,38 years; there were 1203 females (66.9 %). Overweight was recorded in 33.4 % of patients and obesity in 66.6 % of patients. Mean body weight was 92.06±14.03 kg, BMI was 32.38±4.55 kg/m2, WC in males was 104.92±12.74 cm, in females –99.32±12.74 cm, i.e. abdominal obesity was prevailing. Family history of cardiovascular diseases was reported in 60.7 % of patients and 63.6 % have never smoked. Diabetes mellitus or impaired glucose tolerance was observed in 11.06 % of patients. The systolic BP (SBP) was 163.15±12.21 mm Hg, diastolic BP (DBP) was 95.62±7.78 mm Hg, heart rate (HR) was 78.16±8.98 per minute, i.e. in general, severe AH was recorded. At enrolment 38.4 % of patients received one antihypertensive product, 47.8 % of patients received two products and 13.8 % of patients received three and more products (generally renin-angiotensin-aldosterone system modulators in combination with the calcium antagonists and hydrochlorothiazide, more than half – as individual products). Initial compliance (quantity of positive responses) was 3.33 scores and was low in 73.9 % of patients and high only in 4.0 % of patients. Doctors changed the antihypertensive therapy at Visit 1: 84.43 % of patients were recommended the original fixed combination of perindopril and indapamide at 10/2.5 mg; 14.07 % of patients – at 5/1.25 mg; 0.95 % of patients – at 2.5/0.625 mg; 0.56 % of patients were prescribed another antihypertensive therapy. Following 1-month therapy, SBP decreased by 27.12±13.70 mm Hg, DBP decreased by 13.32±9.08 mm Hg, HR decreased by 5.20±8.16 per minute (all p<0.001), which ensured AH control in 74.9 % of patients and improved compliance (p<0.05). Further 1-month treatment led to further decrease in BP. After 2 months, the mean SBP was 130.29±11.58 mm Hg, DBP was 79.37±6.69 mm Hg; it decreased from baseline by 32.87±12.21 and 16.26±8.93 mm Hg (p<0.0001). All BP changes were dose-dependant (dose of the original fixed combination of perindopril and indapamide) and were the highest when the combination at 10/2.5 mg was used. Therapy efficacy and compliance did not depend on the previous treatment or age of patients. BP control was achieved in 93.09 % of patients and compliance improved in 71 %.
Conclusions. Therapy with the original fixed combination of perindopril and indapamide, generally at the highest dose (10/2.5 mg) in previously treated patients with AH and the overweight/obesity is effective and allows to reach BP control after 2-month therapy in 93 % of patients regardless their age and also to significantly improve the compliance.
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