Arterial hypertension (AH) remains the most common cause of disability and mortality in the working-age population of Ukraine among all cardiovascular diseases (CVD) (Kovalenko, V.M., Kornatsky, V.M., 2016; Svishchenko, E.P., Mishchenko, L.A., 2017). Despite the variety of antihypertensive drugs (AHD), blood pressure (BP) control remains unsatisfactory even against the background of antihypertensive therapy (AHT) due to comorbid pathology (Mitchenko, O.I., 2019;Tseluyko, V. Y., 2018; Lutay, M.I., 2017; Amosova, K.M., 2016).
Among the comorbid conditions that can cause additional damage to target organs and affect the course and prognosis of AH, one of the leading places belongs to thyroid dysfunction (TD), the prevalence of which in the world and in Ukraine in particular shows a significant increase in both hypo- and hyperthyroidism and requires adequate measures for its diagnosis and treatment (Cherenko, M.S., 2016; Tsymbaliuk, I.L. 2016; Pankiv, V.I., 2017; Tkachenko, V.I., 2018).
According to modern views, the quality of diagnosis and treatment efficiency of hypertension should be assessed not only by the level of office BP but also by the dynamics of 24-h BP, central systolic BP (cSBP), and the ability to affect left ventricular myocardial hypertrophy (LVMH) regression (Sirenko, Yu. M., Radchenko, H. D. Mishchenko, L. A., Torbas, O. O., 2018).
In order to increase the efficiency and improve the treatment in AH patients against the background of hypo- and hyperthyroidism depending on the compensation of the thyroid state, we studied the dynamics of outpatient blood pressure monitoring (OPBPM), cSBP, structural and functional state of the heart when using double fixed combinations of AHDs of perindopril with indapamide, perindopril with amlodipine, and bisoprolol with perindopril in 130 patients of the clinic of State Enterprise V. Ya. Danilevsky Institute for Endocrine Pathology of the NAMS of Ukraine, 100 of which were AH patients with TD: 50 AH patients with hypothyroidism (HT) (25 (50%) AH patients with compensated HT and 25 (50%) AH patients with decompensated HT) and 50 AH patients with thyrotoxicosis (TT) (25 (50%) AH patients with compensated TT and 25 (50%) AH patients with decompensated TT); 30 AH patients without TD were the control group.
The patients were statistically comparable by gender, age, duration of AH and TD, and the level of office systolic BP (SBP). All AH and HT patients (n = 50), AH patients with compensated TT (n = 25) and patients of the control group (n = 30) were randomized by the sealed envelope method into the groups of a fixed combination of perindopril + indapamide at a daily dose of 5/1.25 mg in the morning on an empty stomach or a fixed combination of perindopril + amlodipine at a daily dose of 5/5 mg in the morning on an empty stomach. AH patients with decompensated TT were prescribed a fixed combination of bisoprolol + perindopril at a daily dose of 5/5 mg in the morning on an empty stomach.
Patients who did not reach the target BP level after 1 month of treatment had their AHT corrected with an increased dose of perindopril to the full therapeutic dose and repeated OPBPM after 1 month, provided satisfactory control of home BP monitoring. Later on, if based on OPBPM indicators the target level of SBP was not reached, the dose of the second drug in the combination was increased to the full therapeutic dose. Patients who received a fixed combined double AHT at the maximum daily dose for 3 months and did not reach the target SBP level were switched to a fixed combined triple AHT and excluded from the study. Echocardiographic (EchoCG) examination was performed after 1 month, provided that the target level of office SBP was reached, and after 1 year of treatment.
