Optimization of treatment in hypertensive patients
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Abstract
The objective: assessement the influence of fixed dose comdination of two nootropic drugs – aminalon and piracetam (Olatropil®) on the neurovegetative, psychoemotional disorders, cognitive decline, circadian blood pressure profile in hypertensive patients, which treated by antihypertensive drugs.
Patients and methods. 55 hypertensive patients were included in open, controlled study of 2 months duration. The patients were divided into two groups – basic and control. The basic group consists of 11 male and 16 female, second group – 10 male and 18 female. The patients of both groups have received identical antihypertensive treatment. Additionally, the basic group was given Olatropil® 3 capsules daily, the control group was given piracetam 400 mg twice daily. For evaluation of the efficacy of examined nootropic drugs the patients have been underwent the neuropsychologocal testing. Circadian blood pressure profile was obtained using 24-h ambulatory pressure monitoring (ABPM) In 17 patients in basic group.
Results.The autonomic system disorders was significantly reduced in patients in both groups, however, more prononced reduction was noticed in basic group after treatment with examined nootropic drugs added to antihypertensive drugs. After including Olatropil® in anti hypertensive scheme, the number of patients with clinical anxiety/depression was singificantly decreased and the number of patients with low level of anxiety was increased. No signifiantely change of these parameters was found in patients treated with piracetam. Treatment with Olatropil® in hypertensive patients impoved the memory characteristics, which reached the normative range. According to data obtained from ABPM, the treatment with Olatropil® was accosiated with restoration of physiological rhytm of blood pressure in 75% of patients, decreasing of unfavorable types of nocturnal blood pressure dipping.
Conclusions. Combination of nootropic drug Olatropil® with anti hypertensive treatment is associated with positive effects such as normalization of vegetative dysfunction, improvement of some cognitive parameters, and decrease in pathological types of night time blood pressure.
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References
Henskens LH, van Oostenbrugge RJ, Kroon AA, Hofman Detection of silent cerebrovascular disease refines risk stratification of hypertensive patients // J Hypertens 2009; 27:846–853.
Gorelick PB, Nyenhuis D, American Society of Hypertension Writing Group. Materson BJ, Calhoun DA, Elliott WJ, Phillips RA, Taler SJ, Townsend RR. Blood pressure and treatment of persons with hypertension as it relates to cognitive outcomes including executive function //J Am Soc Hypertens. 2012;6(5):309–315.
Elias MF, Wolf PA, D’Agostino RB, Cobb J, White LR. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham study //Am J Epidemiol. 1993;138:353–364.
Launer L.J., Masaki K., Petrovitch H., Foley D., Havlik R.J. The assotiation between mid life blood pressure levels and late–life cognitive function. The Honolulu–Asia Aging Study // JAMA. – 1995. – Vol. 274. – P. 1846–1851.
Singh–Manoux A, Marmot M. High blood pressure was associated with cognitive function in middle–age in the Whitehall II study //J. Clin. Epidemiol. – 2005. – Vol. 58. – P. 1308–1315.
Birns J, Kalra L. Cognitive function and hypertension // J Hum Hypertens. – 2009 Feb;23(2):86–96.
Elias P.K., D’Agostino R.B., Elias M.F., Wolf P.A. Blood pressure, hypertension, and age as risk factors for poor cognitive performance // Exp. Aging. Res. – 1995. – Vol. 21. –P. 393–417.
Киландер Л., Ниман Н., Боберг М. и др. Взаимосвязь артериальной гипертензии с когнитивными нарушениями: Результаты 20-летнего наблюдения 999 пациентов // Обзоры клинической кардиологии. – 2005. – No 2. – С. 37–49.
Mossello E, Pieraccioli M, Nesti N, et al.. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs //JAMA Intern Med. 2015;175(4):578–585.
Weidung B, Littbrand H, Nordström P, Carlberg B, Gustafson Y. The association between SBP and mortality risk differs with level of cognitive function in very old individuals //J Hypertens. 2016;34(4):745–752.
Singer J, Trollor JN, Baune BT, Sachdev PS, Smith E. Arterial stiffness, the brain and cognition: a systematic review. //Ageing Res Rev. 2014;15:16–27.
Scuteri A, Tesauro M, Guglini L, Lauro D, Fini M, Di Daniele N, et al. Aortic stiffness and hypotension episodes are associated with impaired cognitive function in older subjects with subjective complaints of memory loss // Int J Cardiol. 2013;169:371–7.
Hajjar I, Goldstein FC, Martin GS, Quyyumi AA. Roles of arterial stiffness and blood pressure in hypertension associated cognitive decline in healthy adults //Hypertension. 2016; 67(1):171–175.
Cooper LL, Mitchell GF. Aortic stiffness, cerebrovascular dysfunction, and memory //Pulse (Basel) 2016;4(2–3):69–77.
Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis //BMJ. 2010;341.
Raz N, Yang YQ, Rodrigue KM, Kennedy KM, Lindenberger U, Ghisletta P. White matter deterioration in 15 months: latent growth curve models in healthy adults. //Neurobiol Aging. 2012;33(2):429–435.
Hering D, Piskunowicz M. Hypertension and ischaemic stroke subtypes. In: Coca A, Manica G, Rosei EA, editors. Hypertension and brain damage. European Society of Hypertension, Working Group Hypertension and the Brain; 2016.
Peters R, Beckett N, Forette F, Tuomilehto J, Clarke R, Ritchie C, et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVETCOG): a double-blind, placebo controlled trial //Lancet Neurology. – 2008; 7:683–689.
McGuinness B, Todd S, Passmore P, Bullock R. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;4:CD004034.
Staessen JA, Thijs L, Babarskiene MR, et al., Systolic Hypertension in Europe Investigators The prevention of dementia with antihypertensive treatment: new evidence from the systolic hypertension in Europe (Syst Eur) study //Arch Intern Med. 2002; 162(18):2046–2052.
Tzourio C, Anderson C, Chapman N, Woodward M, Neal B, MacMahon S, Chalmers J, PROGRESS Collaborative Group Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease //Arch Intern Med. 2003;163(9):1069–1075.
Coca A, Monteagudo E, Doménech M, Camafort M, Sierra C. Can the Treatmentof Hypertension in the Middle Aged Prevent Dementia in the Elderly? //High Blood Press Cardiovasc Prev. – 2016;23(2):97–104.
Sierra C, Doménech M, Camafort M, Coca A. Hypertension and mild cognitive impairment. Curr Hypertens Rep. 2012 Dec;14(6):548–55.
Tadic M, Cuspidi C, Hering D. Hypertension and cognitive dysfunction in elderly: blood pressure management for this global burden. //BMC Cardiovasc Disord. 2016 Nov 3;16(1):208.
Waldstein SR, Rice SC, Thayer JF, Najjar SS, Scuteri A, Zonderman AB. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging //Hypertension. 2008;51(1): 99–104.
Metoki H., Ohkubo T., Kikuya M. et al. Prognostic significance of night time, early morning and daytime blood pressure on the risk of cerebrovascular and cardiovascular mortality: the Ohasame Study //J. Hypertension. – 2006. 24. 1841–1848.
Kherada N, Heimowitz T, Rosendorff C. Antihypertensive therapies and cognitive function: a review //Curr Hypertens Rep. 2015;17(10):79.
Muller FL, Lustgarten MS, Jang Y, Richardson A, Van Remmen H. Trends in oxidative aging theories //Free Radic Biol Med.2007;43:477–503.
Loerch PM, et al. Evolution of the aging brain transcriptome and synaptic regulation. PLoS ONE. 2008;3:e3329
Lu T, et al. Gene regulation and DNA damage in the ageing human brain //Nature. 2004;429:883–891.
Sedensky MM, Morgan PG. Mitochondrial respiration and reactive oxygen species in mitochondrial aging mutants //Exp Gerontol.2006; 41:237–245.
Yankner BA, Lu T, Loerch P. The aging brain //Annu Rev Pathol. 2008;3:41–66.
Yang Y., XU J.Z., Wang Y. Ambulatory versus clinic blood pressure in predicting overall subclinical target organ progression in essential hypertensive patients: a 3 year follow up study. – 2016; 21 (6); 319–326.
Nadic M., Cuspidi C., Pencic Popovic B. The influence of night time hypertension on left ventricular mechan ics // Am. J Hypertens 2017. 6. doi: 10.1093/ajh/hpx096