Improvement of Left Ventricular Circumferential Performance in Subjects with Mild-To-Moderate Hypertension After Three Months Treatment with Barnidipine

Abstract

Introduction: Hypertension is a potent and modifiable risk factor for cardiocerebrovascular diseases, accounting for more than 50% of deaths for stroke and 25% of those for coronary heart diseases. Systolic blood pressure (SBP) increases continuously throughout adult life and the prevalence of isolated systolic hypertension (ISH) rises accordingly, reaching about 60% among those in their sixties and 75% in those aged 75 years and older. Objective: This study was planned to assess prognostic factors influencing the long-term maintenance of the blood pressure in elderly. A retrospective study was performed, studying 127 old patients (mean age 76,7 ± 7,1 years) with a diagnosis of uncontrolled essential hypertension, with an equal distribution between gender. The mean systolic blood pressure was 160 ± 14 mmHg, while the mean diastolic blood pressure was 82 ± 9 mmHg. It was thus prescribed an antihypertensive drug therapy to reach the systolic blood pressure value <140 mmHg and the diastolic blood pressure value < 85 mmHg, that was obtained in 78% of patients. The efficacy of the drug therapy was followed ever 3 months over a period up to 2 years. Results: Results indicated that the monotherapy was effective only in 22 patients (17,3%), while the most part of patients required a combined, multidrug therapy, that for the most cases included a diuretic associated with either a calcium-channel blocker or a drug acting on the renin-angiotensinaldosterone system (RAAS). The prognostic factors involved in the long-term maintenance of the blood pressure were evaluated by a discrete time survival model. The univariate analysis, using the Log-rank test, indicates that only the treatment with an ACE inhibitor drug positively correlated with a long-term efficacy of the antihypertensive therapy (p=0.019). The multivariate analysis unravelled that the presence of hypercholesterolaemia (observed in 46% of patients) was an important negative prognostic factor for the long-term efficacy of the therapy (RR:3.2 IC: 1.3-8.2, p=0.013). The multivariate analysis emphasised as well the role of the RAAS drugs in the treatment of hypertension, confirming that the use of an ACE inhibitor positively correlated with the long-term efficacy of the antihypertensive therapy (Relative Risk: 0.25, CI: 0.10-0.062, p=0.03) and indicating an important role for the sartans. Conclusions: Our data demonstrated indeed that, in hypercholesterolaemic patients, the prescription of a sartan drug allowed the long-term maintenance of the therapy (RR: 0.16 CI: 0.05-0.54, p=0.003), reducing of about 84% the relative risk of the loss of efficacy.