Therapy of patients with the high risk of arterial hypertension with the use of telmisartan

Aim. The study assesses the effects of therapy based on the use of telmisartan in patients with arterial hypertension and stable angina on the clinical and functional indicators of the cardiovascularvascular system. Material and methods. 52 patients with a combination of arterial hypertension (AH) I and II stages and coronary artery disease II with the mean age 63.5 ± 5.4 years (79% males and 21% of females) were enrolled in the trial. The duration of AH and CAD were 17.5±3.8 and 12.5±3.1 accordingly. All patients took a daily 80 mg dose of telmisartan. The efficacy of treatment was estimated in 3,6 and 12 months. Results. The use of telmisartan in complex treatment of high-risk patients with AH has led to decreasing blood pressure to the target level, increasing exercise tolerance (walking the distance from 315.5 m to 410.2 m in 6 minutes). 12 months of therapy based on telmisartan showed significant decrease in left hy‑ pertrophy ventricle (LV myocardial mass index on average by 10.4%), a decrease in the total duration of depression ST segment from 9.6±2.9 to 2.7±1.5 mm and a decrease in the depth of depression from 1.5±0.3 mm to 0.3±0.09 mm, with a trend towards decrease in the number of episodes of ST-segment depression, as well as the absence of a significant change in heart rate. After 12 months of en‑ dothelium-dependent vasodilation therapy, the condition of 31 (60%) patients improved, and 18 (35%) patients showed the tendency to improvement. The tests with reactive hyperemia conducted after 12 months of treatment revealed decreased linear velocity of blood flow in the brachial artery on average by 17%. Conclusion. The use of telmisartan in complex therapy improves the quality of life according to the EQ-VAS questionnaire by 25 points after 12 months of therapy, contributes to lowering blood pressure in 96% of patients, reduc‑ ing myocardial hypertrophy, endothelial dysfunction and severity of ischemic manifestations (reducing the need for nitroglycerin intake to an average of 0,5 inhalations, as well as a decrease in the ST segment depression of 40% after 12 months of therapy).

1. Bliziotis IA, Destounis A, Stergiou GS. Home versus ambulatory and office blood pressure in predicting target organ dam age in hypertension: a systematic review and meta-analysis. Journal of Hypertension. 2012;30(7):1289–99. DOI: 10.1097/ HJH.0b013e3283531eaf

2. Ionov M.V., Zvartau N.E., Konradi A.O. First look at new 2018 joint ESH/ESC Guidelines on diagnosis and management of hypertension. Arterial Hypertension. 2018;24(3):351–8. DOI: 10.18705/1607-419X -2018-243-351-358

3. Rogoza A.N., Oszhepkova E.V., Tsagareshvili E.V., Gorieva Sh.B. Modern non-invasive methods of blood pressure measurement for the diagnosis of hypertension and evaluation of the effectiveness of antihypertensive therapy. Manual for doctors. -M.: Medika;2007. – 72 p. ISBN 978-5-98495-010-7

4. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J et al. Blood pressure lowering for prevention of car diovascular disease and death: a systematic review and meta-analysis. The Lancet. 2016;387(10022):957–67. DOI: 10.1016/S0140 6736(15)01225-8

5. Leonova M.V. The modern view of endpoints for the evaluation of antihypertensive therapy. Good Clinical Practice. 2002;4:18– 22.

6. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair -Rohani H et al. A comparative risk assessment of burden of dis ease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990 -2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet (London, England). 2012;380(9859):2224–60. DOI: 10.1016/S0140 6736(12)61766-8

7. Shubik Yu.V., Baturova M.A., Tregubov A.V. Recommendations for Holter electrocardiogram monitoring: past, present, future. Journal of arrhythmology. 2018;94:57–67. DOI: 10.25760/ VA-2018-94-57-67

8. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al. 2016 European Guidelines on cardiovascular disease preven tion in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by represen tatives of 10 societies and by invited experts). European Journal of Preventive Cardiology. 2016;23(11):NP1–96. DOI: 10.1177/2047487316653709

9. Makarov L.M., Komolyatova V.N., Kupriyanova O.O., Pervova E.V., Ryabykina G.V., Sobolev A.V. et al. National russian guidelines on application of the methods of Holter monitoring in clinical prac tice. Russian Journal of Cardiology. 2014;19(2):6–71.

10. Angeli F, Reboldi G, Poltronieri C, Stefanetti E, Bartolini C, Verdecchia P. The prognostic legacy of left ventricular hypertrophy: cumulative evidence after the MAVI study. Journal of Hypertension. 2015;33(11):2322–30. DOI: 10.1097/HJH.0000000000000692

11. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS et al. Patterns of left ventricular hypertrophy and geomet ric remodeling in essential hypertension. Journal of the American College of Cardiology. 1992;19(7):1550–8. DOI: 10.1016/07351097(92)90617-V

12. Antikainen RL, Peters R, Beckett NS, Fagard RH, Wang J -G, Rajkumar C et al. Left ventricular hypertrophy is a predictor of cardiovascular events in elderly hypertensive patients: Hypertension in the Very Elderly Trial. Journal of Hypertension. 2016;34(11):2280–6. DOI: 10.1097/HJH.0000000000001073

13. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58(6):1072–83. DOI: 10.1161/01.CIR.58.6.1072

14. Devereux RB. Prognostic Significance of Left Ventricular Mass Change During Treatment of Hypertension. JAMA. 2004;292(19):2350–6. DOI: 10.1001/jama.292.19.2350

15. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T et al. 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: Official Publication of the American Society of Echocardiography. 2016;29(4):277–314. DOI: 10.1016/j.echo.2016.01.011

16. Burnier M, Brede Y, Lowy A. Impact of prolonged antihypertensive duration of action on predicted clinical outcomes in imperfectly adherent patients: comparison of aliskiren, irbesartan and ramipril: Effects of adherence and duration of drug action on outcomes. International Journal of Clinical Practice. 2011;65(2):127–33. DOI: 10.1111/j.1742 -1241.2010.02616.x

17. ATS Statement: Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine. 2002;166(1):111–7. DOI: 10.1164/ajrccm.166.1.at1102

18. Lowy A, Munk VC, Ong SH, Burnier M, Vrijens B, Tousset EP et al. Effects on blood pressure and cardiovascular risk of varia tions in patients’ adherence to prescribed antihypertensive drugs: role of duration of drug action: Impact of adherence and duration of action on clinical outcomes with antihypertensives. International Journal of Clinical Practice. 2011;65(1):41–53. DOI: 10.1111/j.1742 -1241.2010.02569.x

19. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet (London, England). 1992;340(8828):1111–5. PMID: 1359209

20. Okin PM, Gerdts E, Kjeldsen SE, Julius S, Edelman JM, Dahlöf B et al. Gender Differences in Regression of Electrocardiographic Left Ventricular Hypertrophy During Antihypertensive Therapy. Hypertension. 2008;52(1):100–6. DOI: 10.1161/ HYPERTENSIONAHA.108.110064

21. Zateyshchikov D.A., Minushkina L.O., Kudryashova O.Yu., Barinov V.G., Tsimbalova T.E., Nosenko E.M. et al. Functional State of Endothelium in Patients with Hypertension and Ischemic Heart Disease. Kardiologiia. 2000;40(6):14–7.

22. Schumacher H, Mancia G. The safety profile of telmisartan as mono therapy or combined with hydrochlorothiazide: A retrospective analysis of 50 studies. Blood Pressure. 2008;17(sup1):32–40. DOI: 10.1080/08038020802144383

23. Novik A.A., Ionova T.I. Guidelines for the study of quality of life in medicine. -St. Petersburg: Neva; M.:OLMA-Press;2002. – 313 p. ISBN 978-5-7654-2112-3

24. Instructions for medical use of the drug Telzap ЛП -003545. https://www.sanofi.ru/-/media/Project/One-Sanofi -Web/ Websites/Europe/Sanofi-RU/Home/healthcare-solutions/cardio vascular/Telzap_PIL_2018-08-03.pdf]

25. Orlov A.I. Applied statistics: a textbook. – M.: Exam;2006. – 671 p. ISBN 5-472-01122-1

26. Böhm M, Schumacher H, Teo KK, Lonn EM, Mahfoud F, Mann JFE et al. Achieved blood pressure and cardiovascular outcomes in highrisk patients: results from ONTARGET and TRANSCEND trials. The Lancet. 2017;389(10085):2226–37. DOI: 10.1016/S01406736(17)30754-7

27. Pollehn T. The electrocardiographic differential diagnosis of ST seg ment depression. Emergency Medicine Journal. 2002;19(2):129– 35. DOI: 10.1136/emj.19.2.129

28. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H et al. Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. New England Journal of Medicine. 2008;358(15):1547–59. DOI: 10.1056/NEJMoa0801317

29. Kapustnik VA, Shelest BO, Kovalyova YuO, Shelest OM, Brek VV. The use of telmisartan in the treatment of arterial hypertension with obesity. Clinical pharamacy. 2018;22(1):4–9. DOI: 10.24959/ cphj.18.1447

30. Nedogoda SV, Ledyaeva AA, Chumachok EV, Tsoma VV, Mazina G, Salasyuk AS et al. Randomized Trial of Perindopril, Enalapril, Losartan and Telmisartan in Overweight or Obese Patients with Hypertension. Clinical Drug Investigation. 2013;33(8):553–61. DOI: 10.1007/s40261-013-0094-9

31. Deneka I.Е., Rodionov A.V., Fomin V.V. The use of telmisartan in patients with refractory arterial hypertension and obesity. Cardiovascular Therapy and Prevention. 2019;18(1):73–81. DOI: 10.15829/1728-8800-2019-1-73-81

32. Bakris G. Comparison of telmisartan vs. valsartan in the treatment of mild to moderate hypertension using ambulatory blood pressure monitoring. Journal of Clinical Hypertension (Greenwich, Conn.). 2002;4(4 Suppl 1):26–31. PMID: 12147926

33. Zhusupova A.M. Hemodynamic parameters in patients with arterial hypertension in the treatment of telmisartan. Medicine and Ecology. 2011;1:135–8.

34. Choi H-J. Blood Pressure Variability and Its Management in Hypertensive Patients. Korean Journal of Family Medicine. 2012;33(6):330–5. DOI: 10.4082/kjfm.2012.33.6.330

35. Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. LongTerm Risk of Mortality Associated with Selective and Combined Elevation in Office, Home, and Ambulatory Blood Pressure. Hypertension. 2006;47(5):846–53. DOI: 10.1161/01. HYP.0000215363.69793.bb

36. Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML et al. Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension. Hypertension. 2008;51(1):55–61. DOI: 10.1161/ HYPERTENSIONAHA.107.100727

37. Bliziotis IA, Destounis A, Stergiou GS. Home versus ambulatory and office blood pressure in predicting target organ dam age in hypertension: a systematic review and meta-analysis. Journal of Hypertension. 2012;30(7):1289–99. DOI: 10.1097/ HJH.0b013e3283531eaf

38. Rogoza A.N., Oszhepkova E.V., Tsagareshvili E.V., Gorieva Sh.B. Modern non-invasive methods of blood pressure measurement for the diagnosis of hypertension and evaluation of the effectiveness of antihypertensive therapy. Manual for doctors. -M.: Medika;2007. – 72 p. ISBN 978-5-98495-010-7

39. Leonova M.V. The modern view of endpoints for the evaluation of antihypertensive therapy. Good Clinical Practice. 2002;4:18– 22.

40. Shubik Yu.V., Baturova M.A., Tregubov A.V. Recommendations for Holter electrocardiogram monitoring: past, present, future. Journal of arrhythmology. 2018;94:57–67. DOI: 10.25760/ VA-2018-94-57-67

41. Makarov L.M., Komolyatova V.N., Kupriyanova O.O., Pervova E.V., Ryabykina G.V., Sobolev A.V. et al. National russian guidelines on application of the methods of Holter monitoring in clinical prac tice. Russian Journal of Cardiology. 2014;19(2):6–71.

42. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS et al. Patterns of left ventricular hypertrophy and geomet ric remodeling in essential hypertension. Journal of the American College of Cardiology. 1992;19(7):1550–8. DOI: 10.1016/07351097(92)90617-V

43. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58(6):1072–83. DOI: 10.1161/01.CIR.58.6.1072

44. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T et al. 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: Official Publication of the American Society of Echocardiography. 2016;29(4):277–314. DOI: 10.1016/j.echo.2016.01.011

45. ATS Statement: Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine. 2002;166(1):111–7. DOI: 10.1164/ajrccm.166.1.at1102

46. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet (London, England). 1992;340(8828):1111–5. PMID: 1359209

47. Zateyshchikov D.A., Minushkina L.O., Kudryashova O.Yu., Barinov V.G., Tsimbalova T.E., Nosenko E.M. et al. Functional State of Endothelium in Patients with Hypertension and Ischemic Heart Disease. Kardiologiia. 2000;40(6):14–7.

48. Novik A.A., Ionova T.I. Guidelines for the study of quality of life in medicine. -St. Petersburg: Neva; M.:OLMA-Press;2002. – 313 p. ISBN 978-5-7654-2112-3

49. Orlov A.I. Applied statistics: a textbook. – M.: Exam;2006. – 671 p. ISBN 5-472-01122-1

50. Pollehn T. The electrocardiographic differential diagnosis of ST seg ment depression. Emergency Medicine Journal. 2002;19(2):129– 35. DOI: 10.1136/emj.19.2.129

51. Kapustnik VA, Shelest BO, Kovalyova YuO, Shelest OM, Brek VV. The use of telmisartan in the treatment of arterial hypertension with obesity. Clinical pharamacy. 2018;22(1):4–9. DOI: 10.24959/ cphj.18.1447

52. Deneka I.Е., Rodionov A.V., Fomin V.V. The use of telmisartan in patients with refractory arterial hypertension and obesity. Cardiovascular Therapy and Prevention. 2019;18(1):73–81. DOI: 10.15829/1728-8800-2019-1-73-81

53. Zhusupova A.M. Hemodynamic parameters in patients with arterial hypertension in the treatment of telmisartan. Medicine and Ecology. 2011;1:135–8.