Assessment of the effect of minimum steady-state concentrations of angiotensin II receptor blockers on the dynamics of office blood pressure values in patients with newly diagnosed stage 1–2 arterial hypertension

E.V. Rebrova, E.V. Shikh

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

Background. Current data indicate insufficient blood pressure (BP) control worldwide: less than 1 in 3 people with arterial hypertension (AH) achieve target BP values in high-income countries, while in middle- and low-income countries this figure drops to less than 1 in 10. Objective. Assessment of the effect of minimum steady-state concentrations of angiotensin II receptor blockers (ARBs) on the dynamics of office BP in patients with newly diagnosed 1–2 degree arterial hypertension. Methods. The study included 179 patients from the Moscow region with newly diagnosed 1–2 degree arterial hypertension and low/moderate risk of cardiovascular complications (CVC), including 141 (78.8%) women and 38 (21.2%) men aged 32 to 69 years (mean age 58.2±6.4, median age 60 (57-63 years), who were randomized to treatment groups with valsartan (80 mg/day) or irbesartan (150 mg/day). Patients with a low CVC risk received ARB monotherapy, while those with a moderate risk of CVC received a combination of ARBs with hydrochlorothiazide. After 3 weeks of pharmacotherapy, the minimum steady-state concentration of irbesartan and valsartan was determined. Office BP measurement was performed upon inclusion in the study, after 3 weeks and after 3 months of therapy. Results. With monotherapy, higher concentrations of irbesartan (p<0.001) and valsartan (p=0.011) were achieved compared to the combination therapy. In patients taking irbesartan, after 3 weeks of pharmacotherapy, a statistically significant more pronounced decrease in office SBP and DBP was found (on average by 1.26 [95% CI: -1.51; -1] mmHg and by 0.86 [95% CI: -1.16; -0.55] mmHg) with an increase in concentration by every 100 ng/ml; statistically significant association of SBP and DBP dynamics with valsartan concentration was not established. Conclusion. The obtained data allow to consider irbesartan monotherapy as a personalized and controlled initial treatment for 1–2 degree arterial hypertension in patients with low cardiovascular risk.

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About the Authors

Ekaterina V. Rebrova, Cand. Sci. (Med.), Associate Professor, Associate Professor at the Department of Clinical Pharmacology and Propaedeutics
of Internal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; katrina1987@rambler.ru, ORCID: https://orcid.org/0000-0002-4374-9754; Scopus Author ID: 57201486509; eLibrary SPIN-код: 9445-5564 (corresponding author)
Evgeniya V. Shikh, Dr. Sci. (Med.), Professor, Director of the Institute of Professional Education, Head of the Department of Clinical Pharmacology
and Propaedeutics of Internal Medicine,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ORCID:
https://orcid.org/0000-0001-6589-7654; Scopus Author ID: 6506179061; eLibrary SPIN-код: 2397-8414; ResearcherID: B-7786-2018

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