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Treatment of arterial hypertension and chronic heart failure in patients with pronounced myocardial hypertrophy without left ventricular outflow tract obstruction

Demkina A. E.1, Khashieva F. M.1, Krylova N. S.1, Kovalevskaya E. A.2, Poteshkina N. G.1
1 – State Budgetary Educational Institution of Higher Professional Education, “N.I. Pirogov Russian National Research Medical University” of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997
2 – State Budgetary Institution of Health Care, “Municipal Clinical Hospital #52 of the Moscow Department of Health Care”, Pekhotnaya 3, Moscow 123182

Keywords: hypertrophic cardiomyopathy, ACE inhibitors, perindopril, ventricular systolic and diastolic function

DOI: 10.18087/rhfj.2015.3.2013

Background. In patients of older age groups, arterial hypertension (AH) in combination with CHF symptoms associated with hypertrophic cardiomyopathy (HCMP) creates conditions, when monotherapy with recommended drugs is insufficient to achieve target BP and improve clinical status of the patients. Aim. To study efficacy of the ACE inhibitor, perindopril, as a part of beta-blocker (BB) based combination therapy in patients with nonobstructive HCMP (NHCMP) and AH. Materials and methods. 29 patients with NHCMP and AH (20 females, mean age 59.2±14.0) were evaluated. Patients were randomized to two groups: group 1 included 9 patients (5 females; mean age 52.6±18.0) receiving bisoprolol 6.2±3.0 mg; group 2 consisted of 20 patients (15 females, mean age 62.5±10.5) receiving perindopril 3.7±1.4 mg in addition to bisoprolol 5.0±1.0 mg. The study involved evaluation of patients’ clinical status using the Minnesota Living with Chronic Heart Failure (CHF) Questionnaire (MLHFQ); the Clinical Condition Scale (CCS) for CHF patients; measurement of plasma brain natriuretic peptide (BNP); 24‑h BP monitoring (24h-BPM); and EchoCG with tissue Doppler imaging (TDI). The study was performed after randomization and after 6‑month follow-up. Results. In an intragroup comparison after 6 months of treatment, patients of group 2 showed significant decreases in CHF NYHA functional class (р=0.02), CCS score (р=0.005), BNP level (р=0.003), mean systolic BP (mSBP) (р=0.0006), mean diastolic BP (mDBP) (р=0.0001), isovolumetric relaxation time (IVRT) of transmitral flow (р=0.01), right ventricular Tei index (р=0.03), segmental ivrt’ of lateral mitral fibrous annulus (MFA) (р=0.01), and an increase in the s’ peak of lateral MFA (р=0.005) by TDI data. After the 6‑month follow-up, patients of group 1 showed a decrease in total CCS score (р=0.04) and an increase in BNP (р=0.04) without changes in parameters of EchoCG, TDI and 24h-BPM. After 6 months of therapy, an intergroup analysis showed that values of mSBP (р=0.02), right ventricular Tei index (р=0.03), and segmental ivrt’ (р=0.03) of lateral and septal MFA sites by TDI data were lower in group 2 than in group 1 while systolic peaks (s’) on lateral and septal MFA were higher than in group 1 (р=0.03). Conclusion. Addition of the ACE inhibitor, perindopril, to the BB treatment improved the clinical status, reduced BNP levels, improved diastolic and systolic function of both ventricles and reduced BP in patients with NHCMP in combination with AH.
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Demkina A. E., Khashieva F. M., Krylova N. S., Kovalevskaya E. A., Poteshkina N. G. Treatment of arterial hypertension and chronic heart failure in patients with pronounced myocardial hypertrophy without left ventricular outflow tract obstruction. Russian Heart Failure Journal. 2015;16 (3):153–160

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