Optimization of Pharmacotherapy Within the Framework of a Patient-oriented Approach in the Treatment of Hypertension in Multimorbidity Patients (Clinical Case and Literature Review)
Open Access
- 3 March 2021
- journal article
- review article
- Published by Silicea - Poligraf in Rational Pharmacotherapy in Cardiology
- Vol. 17 (1), 124-132
- https://doi.org/10.20996/1819-6446-2020-11-07
Abstract
Arterial hypertension (AH) remains one of the main causes of disability and death worldwide, including in Russia. At the same time, the risks of coronary and cerebrovascular events increase in the presence of additional risk factors. The most common modifiable risk factors are metabolic disorders, including pre-diabetes, dyslipidemia, peripheral arterial atherosclerosis, and obesity, which also imposes certain features on the choice of optimal pharmacotherapy. Currently, the terminology of comorbid conditions continues to be discussed depending on their pathogenesis and the presence or absence of dominance of one disease over others, i.e. polymorbidity, comorbidity and multimorbidity. At the same time, “associative polymorbidity” is distinguished with a certain set of diseases that often occur in conjunction with each other with individual susceptibility of the body. One of the most common phenotypes of polymorbidity occurring in all age groups in both sexes is cardiometabolic, which is based on the formation of insulin resistance, sympathetic overactivity and chronic inflammation. This article provides a clinical example of the use of a fixed combination of angiotensin II receptor blocker telmisartan and calcium channel blocker amlodipine with the addition of an I1-imidazoline receptor agonist moxonidine in real clinical practice in a polymorbid cardiometabolic patient with target organ damage (left ventricular hypertrophy and microalbuminuria). High antihypertensive (favorable effect on 24-hour blood pressure, especially in the early morning) and organoprotective effectiveness of this combination, its possibilities in correcting additional risk factors (reduced heart rate, body weight and a positive effect on metabolic parameters), due to a synergistic effect on the central pathogenetic mechanisms of hypertension and obesity – insulin resistance and sympathetic overactivity.Keywords
This publication has 39 references indexed in Scilit:
- Improved Hypertension Control with the Imidazoline Agonist Moxonidine in a Multinational Metabolic Syndrome Population: Principal Results of the MERSY StudyInternational Journal of Hypertension, 2013
- Multimorbidity Patterns in Primary Care: Interactions among Chronic Diseases Using Factor AnalysisPLOS ONE, 2012
- Morning Surge in Blood Pressure and Cardiovascular RiskHypertension, 2010
- Resting Heart Rate Pattern During Follow-Up and Mortality in Hypertensive PatientsHypertension, 2010
- Results of a comparative, phase III, 12-week, multicenter, prospective, randomized, double-blind assessment of the efficacy and tolerability of a fixed-dose combination of telmisartan and amlodipine versus amlodipine monotherapy in Indian adults with stage II hypertensionClinical Therapeutics, 2007
- Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and CostsJournal of General Internal Medicine, 2007
- International Union of Pharmacology. LXI. Peroxisome Proliferator-Activated ReceptorsPharmacological Reviews, 2006
- Preventing renal complications in diabetic patients: the Diabetics Exposed to Telmisartan And enalaprIL (DETAIL) study*Acta Diabetologica, 2005
- The central role of fat and effect of peroxisome proliferator-activated receptor–γ on progression of insulin resistance and cardiovascular diseaseThe American Journal of Cardiology, 2003
- Influence of heart rate on mortality among persons with hypertension: The Framingham StudyAmerican Heart Journal, 1993