Effectiveness of diagnostics and treatment of complicated hypertensive disease taking into account results of 3 day arterial pressure monitoring]

Empirical choice of antihypertensive therapy (AGT) for patients with complicated hypertensive disease (HD) encounters difficulties due to high variability of arterial pressure (AP) and inadequate response to intake of medicines. The objective methods for the choice of AGT methods are absent.To evaluate effectiveness ofthe choice of AGT taking account of AP profile calculated based on the analysis of results of 3 day AP monitoring in patients with complicated HDfor whom the empirical prescription of medicines does not give the desirable result.The study included 51 patients aged 56 +/- 19 yr with HD 18 +/- 13 yr in duration without adequate control of AP despite combined AGT AD was measured (BPLab, Nizhni Novgorod) every 30 min for 3 days, the AP profile was calculated by special FORM-based algorithm. Peak time and magnitude were calculated, the first and second derivatives of the process were determined, AGT was prescribed at the computed AD maximum points.Systolic and diastolic AP decreased within 2 weeks after AGT The number of patients with enhancedAP in the daytime and at night and those with highly variable AP decreased from 33 to 11% (chi2 = 8.4, p < 0.005), from 61 to 33% (chi2 = 10.1, p < 0.005), from 51 to 26% (chi2 = 8.2, p<0.005) respectively. The number ofpatients with inadequate lowering of night-time AP and those with abnormally high fluctuations of AP decreased from 53 to 24% (chi2 = 9.3, p < 0.005) and from 31 to 15%, (p < 0.005) respectively. The frequency of intake of AGT drugs did not change.Approximation of real AP circadian profile fluctuations based on results of 3 day monitoring is a sensitive diagnostic tool facilitating the choice of rational AGT for patients with markedly altered circadian rhythms when empirical prescription of AGT does not ensure desired control ofAP