Abstracts e553
Methods: In hypertensive patients (n ¼ 122, mean ages; 67 years) who
treated and not well-controlled using standard dose of ARB, CCB, diuretic
or these combinations at least for 3 months were enrolled. They were divided
with/without CKD or Mets according to the new diagnostic criteria in Japan,
respectively. At 6 month after the switching to high-dose ARB (valsartan;
160 mg/day), blood pressure, some of hypertensive organ damage markers,
renal function, and metabolic syndrome related factors were evaluated.
Results: Systolic (p < 0.01) and diastolic BP (P < 0.01) have been signifi-
cantly decreased already at 1 month after the switching and these effects
were kept to 6 months. Hs-CRP and serum BNP revealed no significant
differences, however, urinary albumin index (p < 0.05) could be significantly
reduced and this was more effective in Mets (p < 0.05 vs non-Mets). There
was no significant changes in fasting blood glucose, however, HOMA-IR
(p < 0.05), fasting-IRI (p < 0.05) and triglyceride (p < 0.05) were significantly
decreased and these were more significantly reduced in Mets (p < 0.05 vs
non-Mets). On the other hand, eGFR was significantly decreased at 6 month,
however it was significantly maintained in CKD (p < 0.05 vs non-CKD). No
severe adverse effect was observed during treatment.
Conclusion: Switching for high-dose valsartan indicated not only blood
pressure lowering effect but also improving for organ damage markers,
especially renal function in CKD and insulin resistance in Mets complicated
with hypertension. Severer control of blood pressure using high-dose ARB
was consequent strategy to reduce cardiovascular complications in hyper-
tensive subjects with CKD or Mets.
PP.33.343 THERAPEUTIC DECISION FOR UNCONTROLLED
AND UNTREATED HYPERTENSIVE PATIENTS:
DIFFERENCES BETWEEN CARDIOLOGISTS AND
GPS – REFLEXE STUDY
B. Fiquet1, S. Quere1, A. Francillon1, M. Galinier2. 1Novartis Pharma SAS,
Clinical Research and Development, Rueil Malmaison, France, 2CHU Rangueil,
Cardiology Department, Toulouse, France
The study aim was to observe the therapeutic decision made by GPs or
cardiologists for uncontrolled and untreated hypertensive patients (pts)
(BP> ¼ 140/90 for non diabetic (DB) and BP>¼130/80mmHg for DB pts).
Three treatment approaches were assessed: lifestyle and diet recommen-
dations without treatment (LD), implementation of a single drug antihyper-
tensive treatment (SD) or prescription of two antihypertensive agents (TD).
French cross sectional study conducted with 1048 GPs and 155 cardiologists
in 2008. Each physician included the first 5 consecutive hypertensive pts
according to above inclusion criteria. Cardiovascular (CV) risk factors (RF)
and associated diseases were collected to compare pts characteristics in the
3 groups.
5201 pts were included by GPs and 764 pts by cardiologists (see table below).
Overall physicians mostly chose to start an antihypertensive treatment: only
7.9% of pts followed by GPs remained without treatment versus 10.6% of pts
managed by cardiologists.
Cardiologists were more disposed to immediately prescribe a two-drug
regimen than GPs, respectively 32.7 and 22.9%, even though their patients
didn’t have more severe HTN or more associated cardiovascular risk factors
or diseases.
Therapeutic management for uncontrolled and untreated hypertensive
patients differ between cardiologist and GPs, with cardiologists adopting
a more aggressive approach despite the same cardiovascular risk of their pts.
The more frequent ambulatory BP measurement prescribed by cardiologists
could explain partly the differences observed in therapeutic decision.
PP.33.344 ANTIHYPERTENSIVE TREATMENT ÀNALYSIS IN
HYPERTENSIVE TYPE II DIABETES PATIENTS
M. Barabanschikova, L.S. Pak, E.A. Prochorovich. Moscow Medical Stomato-
logical State University, Moscow, Russia
Objective: The aim was to evaluate the antihypertensive treatment admin-
istration with observed drug classes, and its pharmaceutical substance and
dosage in patients with hypertension and diabetes mellitus type II in routine
general practice.
Design and Methods: Clinical data, evaluation of medications and target
drug dosage, risk factors controls were recorded from 288 hypertensive type
II diabetes patients attended Moscow city cardiologic outpatient clinic in
2005–2006 years.
Results: The study included patients of mean age 59.6
9.6 years, females
was 66.7%. Medical history of diabetes was 4.1
0.1 years, arterial hyper-
tension duration was 10.2
0.1 years. Mean SBP was 145.9
31.4 mmHg
and DBP 86.6
17.4mmHg. The treatment management included antihy-
pertensive drugs used in 94.4% patients, hypolipidemic therapy was given
for 28.8% of patients, administration of hypoglycemic drugs were registered
in 59.4% of attendees, 55.9% of group had antithrombotic treatment. The
antihypertensive drugs prescribed were ACE inhibitors used in 80,2%, beta
blockers in 61.1%, calcium antagonist in 30.9%, diuretics 47.6% of all
patients accordingly. The structure of the hypertensive drug was modified
by the specialized cardiology clinic in comparison with general outpatients
practice for wide usage of ACE inhibitors and calcium channel blockers with
prolonged action and selective beta-blockers. Regarding ACE-inhibitors:
perindopril was recommended in 26.3%, fosinopril in 28.1% and intake
captopril 0.4%. The administered dosage was for fosinopril 18.1
2.6 and
perindopril 4.0
0.1. The structure of the beta-blockers changed from
decreased atenolol administration in 11.5%, increased metoprolol intake
in 32.3%. The administered used dosage for atenolol was 56.0
5.2 and
metoprolol 51.4
6.7. On the therapy only 4.4% of patients have reach the
BP < 130/80 mm Hg.
Conclusion: In hypertensive type II diabetes patient’s ACE inhibitors were
the most widely used antihypertensive drugs as recommended in current
guidelines. The target dosage has greater impact on the efficient BP control
than the class of antihypertensive drug. The dosage of the administered
antihypertensive drug should be tightly controlled in order to reach the
target BP levels.
PP.33.345 THE EFFECT OF IRBESARTAN AND LOSARTAN ON
BLOOD PRESSURE AND COGNITIVE FUNCTION IN
HYPERTENSIVE PATIENTS
N. Afanasyeva, V. Mordovin. Research Institute of Cardiology of Siberian Branch
of Russian Academy of Medical Sciences, Tomsk, Russia
Background and Purpose: Cognitive impairment also arises at early stages of
hypertension. Angiotensin receptor blocker (ARB) suppress activity of
sympathetic nervous system and are capable to eliminate factors which raise
vascular risk in hypertensive patients. The aim of the present study was to
study hypotensive and ñerebroprotective efficacy of ARB irbesartan and
losartan in hypertensive patients.
Methods: Forty five hypertensive patients (21 women and 24 men), aged
between 28–56 years, were randomized to treatment with either blockers
irbesartan 150–300 mg or losartan 50–100 mg during 6 month. 24-hours
ambulatory blood pressure monitoring and neurocognitive assessment by
Wechsler Memory Scale (WMS) were performed in all patients at baseline
and in course of the treatment.
Results: Irbesartan reduced significantly 24-h SBP (with 156.8 mm Hg up
to 134.0 mm Hg; P ¼ 0.009), 24-h DBP (with 96 mm Hg up to 88 mm Hg;
P ¼ 0.012), time-index 24-h SBP (with 72% up to 44%; P ¼ 0.014) and
time-index 24-h DBP (with 64% up to 42%; P ¼ 0.018). Losartan reduced
significantly 24-h SBP (with 148.8 mm Hg up to 132.0 mm Hg; P ¼ 0.008),
24-h DBP (with 98 mm Hg up to 89 mm Hg; P ¼ 0.024), time-index 24-h
SBP (with 58% up to 42%; P ¼ 0.028) and time-index 24-h DBP (with 46%
up to 38%; P ¼ 0.034). Later 6 months hypotensive therapies by results of
proof test were marked statistically significant reduction the quantity of
errors (irbesartan with 6 up to 1.8; P ¼ 0.003, losartan with 5 up to 4.2;
P ¼ 0.062). By results of tables of Shulte psychomotor speed has increased
(irbesartan with 48 sec up to 36 sec; P ¼ 0.026, losartan with 48 sec up to
44 sec; P ¼ 0.242), indicators of long-term memory have increased (irbe-
sartan with 68.5 word up to 52.6 word; P ¼ 0.005, losartan with 60.4 word
up to 56.2 word; P ¼ 0.084).
Conclusions: Our study demonstrates, that long controllable treatment of
hypertension with irbesartan and losartan reduces blood pressure and
improves cognitive function. The most expressed positive effect on cogni-
tion rendered irbesartan.