Българска Лига по Хипертония

THE IMPLEMENTATION OF 2007 EUROPEAN GUIDELINES FOR THE TREATMENT OF HYPERTENSION FROM BULGARIAN PHYSICIANS

St. Naydenov, Sv.Torbova, Sv.Tsonev, N. Madjarova

Objective: The aim of the study was to assess the approach for the treatment of hypertensive outpatients from Bulgarian physicians – general practitioners and cardiologists. Material and methods: An open, cross-sectional study was performed from July to November 2009 year in medical centers for outpatients in Bulgarian middle –sized cities. At the regular visits of hypertensive patients, blood pressure (BP) was measured and the last treatment was filled in a questionaire form by the treating physician. One thousand and fifty-two hypertensive patients, mean age 63.8 (24-90) years were included in the study. Results: The mean values of the population’s systolic and diastolic BP were 147.41 and 89.34 mmHg respectively. The last drug treatment was as follows: renin-angiotensin-aldosterone system blockers – 60.4% (angiotensin-convering enzyme inhibitors – 72.8% and angiotensin receptor blockers – 18.1%), diuretics – 56.3% (Indapamide – 72.8% and Hydrochlorothiazide – 26. 6%), beta blocker – 38.2%, calcium channel blockers – 32.4% and others – 5.5%. Single-pill combination received 29% of the treated hypertensives. Initial therapy was monotherapy in 41%. Statins are included in the therapy of 44% from all screened hypertensives. From the hypertensives with cardiovascular diseases statins received as follows: 69% of the patients with ischemic heart diseases, 57% with cerebrovascular diseses, 44% with atrial fibrillation. The administration of diuretics in hypertensives >66 years is higher than hypertensives <65 years - 65 versus 48.5%, p<0.05. No statistically significant difference was found regarding the administration of other antihypertensive drugs by gender (males/females) and age (<65 and >66 years).  Conclusions The treatment of the Bulgarian hypertensive patients in 2009 year follows the recommendations of ESH/ESC with regard to the the choice of drugs. Administration of monotherapy as an initial treatment is still high. Additional statin therapy is included in the treatment of hypertensives for secondary and primary cardiovascular diseses prevention in high percentage of hypertensive patients.

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CHARACTERIZATION AND CONTROL OF ARTERIAL HYPERTENSION AND SOME RISK FACTORS IN BULGARIAN URBAN POPULATION

St. Naydenov, Sv. Torbova, V.Sirakova, J.Jotov, Sn.Tisheva, Sv.Tsonev, E.Shipkovenska

Objective: The aim of the study was to assess some characteristics of arterial hypertension (AH) and concomitant risk factors – diabetes mellitus, dyslipidemia and their treatment in Bulgarian urban population. Material and methods: A cross-sectional pilot study was performed on the World Hypertension Day – the 17th of May, 2009 in four Bulgarian cities. The participants, 814 persons, mean age 57.8 years – 375 males and 439 females filled in an interview for history and treatment of AH and concomitant risk factors. Blood pressure (BP), height and weight were measured by trained medical students. Results: 433 participants (53,2%) had diagnosed AH and 162 (19,9%) were newly detected hypertensives. Two hundred and twenty-nine (26,9%) persons had normal BP and no history of AH. High BP (>140/90mmHg) was found in 358 persons – 44% from the general screened population and 61% from the hypertensive population (diagnosed and newly detected). According to the level of the systolic and diastolic BP of the hypertensive population, the data was as follow: Hypertension 1st grade (140-159/90-99 mm Hg) – 34%, 2nd grade (160-179/100-109 mmHg) – 18%, 3rd grade (>180/110 mmHg) – 9%, isolated systolic hypertension (>140/<90mmHg) – 22%, isolated diastolic hypertension (<140/>90mm Hg) – 17%. The treated hypertensives declared no changes in the BP level in compareson to the last year in 48,5 %, lower BP – 20.8% and higher BP – 16.5%. Concomitant diabetes mellitus (DM) was present in 18,3% of the hypertensives. Drug treatment for DM received 78.8% of the diagnosed diabetics. Diagnosed hypercholesterolemia was declared by 24.7%, normal blood level of cholesterol – 46.4%, 28.9% answered “I do not know”. Treatment for high total cholesterol declared 47.8 % of the diagnosed persons with high cholesterol. Conclusion: The level of uncontrolled arterial hypertension in Bulgarian urban population is still high, especially for systolic BP. High percentage of hypertensives receive statins. The follow-up and treatment of hypertension have too big room for improvement. 

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EFFICACY OF DIRONORM (LISINOPRIL 10 MG/AMLODIPIN 5 MG) IN THE TREATMENT OF UNCONTROLLED HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROM

St.Naydenov, Sv.Torbova, G.Gentchev

Objective:To compare the efficacy of sinlge-pill combination DIRONORM (Lisinopril 10 mg/Amlodipin 5mg) in the treatment of uncontrolled hypertensive patients with and without metabolic syndrome (MS). Material and method: An open multi-center study was performed in 20 Bulgarian medical city centers. One hundred and forty-eight high risk hypertensive patients – 73 with and 75 without MS where included. All patients where uncontrolled with 1 or 2 drugs. The demographic data and baseline systolic blood pressure(SBP) and dyastolic blood pressure (DBP) were similar. The mean value of the body-mass index (BMI) of the group with MS was 29,47 kg/m2 and of the control group – 26,16 kg/m2, (p<0,001). The treatment began with Dironorm Р… to 2 tablets daily and continued for 2 months. Measurement of BP was performed at weeks 1, 2, 4 and 8. The dose titration was made at weeks 1 and 2 and a diuretic added at week 4 if the control of the BP was not achieved.  Results: For the patients with MS, treated only with Dironorm, the BP control was achieved as follow: 1st week 32%, 2nd week 76%, 4th week 88% and 8th week 92%. The corresponding control rate for the group without MS was as follows: 1st week 48,15%, 2nd week 77,75%, 4th week 96,3% and 8th week -100%. The comparison of the BP control rate achieved with Dironorm for the patients with and without MS showed a better effect for the last group, but the difference was n.s. When the thiazide diuretic was added at the 4th week the control rate at the end of the study – 8th week for the patients with MS was 91,67% and 89,58% for the control group (n.s.).  Conclusion: The efficacy of single-pill combination DIRONORM is very high for the patients with MS, comparable with the patients without MS. The higer efficacy for the patients with MS (ns) is achieved if diuretic is added.