Arterial hypertension: the accent on the target organs’ protection
Background. Prolonged untreated arterial hypertension (AH) is accompanied by the damage of target organs (brain, eyes, kidneys, heart and large vessels). This problem can be prevented by the stable control of blood pressure (BP).
Objective. To identify the main strategies for the target organs protection in AH.
Materials and methods. Analysis of the available guidelines and literature data; the own study of L-arginine (Tivortin, “Yuria-Pharm”) administration.
Results and discussion. BP lowering is an integral part of improving the outcome in patients with AH. Reduction of systolic BP by 10 mm Hg leads to the reduction of stroke risk by 27 %, heart failure risk – by 28 %, coronary heart disease risk – by 17 %. The primary goal of treatment of all patients with AH is to achieve the BP level <140/90 mm Hg, in case of good tolerability – <130/80 mm Hg. More intensive treatment with the achievement of BP <130/80 mm Hg provides a more pronounced reduction of the risk of cardiovascular events. Reduction of systolic BP <120 mm Hg is not reasonable. In patients with AH and chronic kidney disease, the target systolic BP should be 130-140 mm Hg. It is important to achieve normalization of BP quickly (within 3 months of treatment), as an early control of this parameter provides a better prognosis (VALUE study). The treatment strategy for uncomplicated AH involves initial therapy with a two-component combination in a single tablet (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) + calcium channel blocker (CCB) or diuretic). At the next stage, a triple combination (ACEI/ARB + CCB + diuretic) is prescribed. According to the indications, β-blockers can be added at any stage. It is necessary to use drugs with proven organoprotective properties based on the target organs affection and concomitant nosological conditions of each individual patient. Even in patients with resistant AH long-term antihypertensive therapy improves renal function and reduces left ventricular hypertrophy. Additional ways of organoprotection in hypertension include the influence on the vascular endothelium condition. According to the results of our own study, the inclusion of L-arginine (Tivortin, “Yuria-Pharm”) into the basic therapy of AH can significantly reduce albuminuria compared with the control group (basic therapy without L-arginine), as well as improve the flow-dependent vasodilation (from 6.7 to 13.6 %, whereas in the control group this parameter has changed from 6.5 to 9.8 %; p<0.001). In the L-arginine group, the glomerular filtration rate also increased significantly, while in the control group this indicator decreased. The renal artery resistance index also decreased (from 0.68 to 0.65 units; no changes were recorded in the control group).
Conclusions. 1. To prevent the damage of target organs, it is necessary to quickly and stably reduce BP to the target values. 2. It is advisable to prescribe antihypertensive drugs with proven organoprotective properties. 3. L-arginine (Tivortin) improves the condition of the endothelium, thereby promoting vasodilation and improving renal function.
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