Babliak S. Resistant hypertension in the elderly: risk factors, left ventricular remodeling and features treatment

The study included 80 patients with resistant hypertension (RAH) and 490 patients with controlled hypertension (CAH). RAH was observed among 31 men and 49 women (38.7% and 61.3%, respectively) and the group with CAH included 222 men and 268 women (45.3% and 54.7%, respectively). The age of patients ranged from 60 to 89 years, amidst the patients with RAH and CAH average values were 72.7 and 73.1 years, respectively. We have gotten new evidence-based results that solve the actual problem of modern cardiology - improving the quality of diagnosis and effectiveness of RAH treatment based upon study of risk factors, comorbidity, pathological remodeling of the left ventricle (LV), daily monitoring of blood pressure (DMBP), dynamics of biochemical parameters, hemostasis and blood lipid spectrum, their correction by the combined antihypertensive treatment with the inclusion of carvedilol, urapidyl, or spironolactone as the 4th drug. During the statistical analysis of the causes of risk of RAH among patients we defined socio-demographic factors, forms of cardiac and non-cardiac diseases, certain hemodynamic and anthropometric parameters and preliminary usage of specific pharmacological groups of antihypertensive agents, which in their combination significantly increases the probability of this disease's detection among elderly patients. Usage of international scales INTERHEART and PROCAM can detect an increased risk of fatal coronary patients with RAH in this age range comparing to patients with CAH, especially among women. Also, among patients with RAH significantly higher prevalence of pathological LV remodeling is observed, mainly due to concentric hypertrophy (COH). Administration of urapidyl (60-180 mg/day in 2 divided doses) for 6 months (average dose 103,33 mg/day) as a supplement to the basic 3-component antihypertensive therapy helped achieve target levels of blood pressure in majority of studied persons (92.6%), was accompanied by normalization of laboratory values and a decrease in severity of pathological ventricular remodeling, decrease of the frequency of hospitalization and complications. In its comprehensive positive impact upon the clinical course of disease urapidyl exceeded the effects of spironolactone and carvedilol. Industry - medicine.