Blutdruck- und ST-Streckenanalyse bei Patienten mit arterieller Hypertonie: Einfluss von Candesartan/Hydrochlorothiazid

Zusammenfassung

Hintergrund und Fragestellung: In dieser Studie wurden prospektiv Blutdruck- und ST-Streckenparameter bei unkontrollierter arterieller Hypertonie (Praxisblutdruck > 140/90 mmHg trotz Einnahme von zwei Antihypertensiva) vor und nach Substitution mit Candesartan/Hydrochlorothiazid untersucht.

Patienten und Methoden: 51 Patienten (34/17 m/w) führten in einer „Run-in-Phase” (4 Wochen) und in einer anschließenden Beobachtungsphase (8 Wochen) eine Blutdruckselbstmessung (BDSM) durch. 24-Stunden-Blutdruck- und ST-Streckenparameter wurden jeweils nach Ende der Wochen 4 und 12 evaluiert. Nach der „Run-In-Phase” waren laut BDSM und 24-Stunden-Blutdruckmessung 10 Patienten normotensiv (Gruppe A) und 41 hypertensiv (Gruppe B). In Gruppe B wurde nun die am wenigsten wirksame Komponente der antihypertensiven Therapie durch Candesartan/HCT ersetzt.

Ergebnisse: In Gruppe A zeigten die BDSM- und 24-h-ABDM-Parameter keinen signifikanten Unterschied zwischen „Run-in”- und Beobachtungsphase. In Gruppe B (n = 41) wurde der systolische Blutdruck nach Umstellung auf Candesartan/Hydrochlorothiazid signifikant gesenkt (24-Stunden ABDM: 148/ 81 vs. 137/75mmHg; p = 0,0015, BDSM: 155/84 vs. 147/ 81mmHg; p < 0,0073). Vor Substitution mit Candesartan/HCT hatten 15 Patienten der Gruppe B ST-Senkungen. Patienten der Gruppe A und die restlichen Patienten der Gruppe B hatten in keiner der beiden Phasen ST-Senkungen. Bei den Patienten mit ST-Senkungen wurde unter Candesartan/HCT die Ischämiedauer pro Patient von 106 auf 72 Minuten, die absolute Anzahl der ST-Senkungen von 228 auf 153 Ereignisse und die mittlere Dauer der ST-Senkungen von 372 auf 210 Sekunden signifikant reduziert.

Folgerung: Durch die Substitution mit Candesartan/HCT konnte bei Patienten mit unkontrollierter arterieller Hypertonie der Blutdruck signifikant gesenkt werden. Das Ausmaß der im Alltag mittels EKG detektierten ST-Streckensenkungen konnte deutlich reduziert werden.

Summary

Objective: To examine the effect of candesartan cilexetil with hydrochlorothiazide (6 mg and 12.5 mg, respectively) on blood pressure and ST-segment depression during daily life of patients with treated but not controlled arterial hypertension (blood pressure taken at doctor's practice ³140/90 mmHg, despite being on at least two antihypertensive drugs)

Patients and methods: 51 patients (45 men, 17 women) with treated but reportedly uncontrolled hypertension were placed on self-measurement of blood pressure for 4 weeks of a run-in period and 8 weeks as a follow-up period. Combined 24-hour automatic blood pressure measurement (ABPM) and electrocardiography were done at the end of the run-in and the follow-up periods. Ten patients proved to be normotensive according to the self-measurement and ABPM after the run-in period (group A), while 41 were still uncontrolled according to both methods (group B). In group B the least efficacious component of the antihypertensive medication was replaced by candesartan with hydrochlorothiazide (C + HCT) and any changes in blood pressure and ST-segment depression analysed after 8 weeks of follow-up in both groups.

Results: In group A no significant blood pressure change was observed between run-in- and follow-up periods. But in group B (n=41) the self-measured systolic blood pressure had significantly decreased (155/84 mmHg compared with [vs] 147/81 mmHg; p<0.0073) as had the systolic 24-h ABPM (148/81 mmHg vs 137/753 mmHg; p<0.0015) after C + HCT had replaced the previous noneffective medication. After the run-in period 15 patients of group B had ST-segment depression (1 mm of horizontal or descending depression for at least 1 minute). In 16 other patients of group B and in all patients of group A no ST depressions were recorded. At the end of the follow-up period significant reduction of mean ischemic burden per patient (106 vs 72 minutes), of total ischemic events (228 vs 153) and of mean duration of ST depression (372 vs 210 seconds) had occurred.

Conclusions: Replacing candesartan + hydrochlorothiazide for previously ineffective antihypertensive drugs in patients with uncontrolled arterial hypertension significantly reduced both blood pressure and ST-segment depression during daily life.

Schlüsselwörter

arterielle Hypertonie - stumme Myokardischämie - kombinierte 24-h ABDM/EKG - AT1- Rezeptor- Blocker

Key words

uncontrolled arterial hypertension - silent myocardial ischemia - combined 24-h ABPM/ECG - AT1-receptor- antagonist

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