[email protected]

Abstracts

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 significantly 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 hypertensive 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 recommendations without treatment (LD), implementation of a single drug antihypertensive 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 A`NALYSIS IN HYPERTENSIVE TYPE II DIABETES PATIENTS

M. Barabanschikova, L.S. Pak, E.A. Prochorovich. Moscow Medical Stomatological State University, Moscow, Russia

e553

Objective: The aim was to evaluate the antihypertensive treatment administration 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 hypertension 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 antihypertensive 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 n˜erebroprotective 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 (irbesartan 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 cognition rendered irbesartan.