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

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Abstract

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

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

Author for correspondence.
Email: katrina1987@rambler.ru
ORCID iD: 0000-0002-4374-9754
SPIN-code: 9445-5564
Scopus Author ID: 57201486509

Cand. Sci. (Med.), Associate Professor, Associate Professor at the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine

Russian Federation, Moscow

Evgeniya V. Shikh

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

Email: katrina1987@rambler.ru
ORCID iD: 0000-0001-6589-7654
SPIN-code: 2397-8414
Scopus Author ID: 6506179061
ResearcherId: B-7786-2018

Dr. Sci. (Med.), Professor, Director of the Institute of Professional Education, Head of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine

Russian Federation, Moscow

References

  1. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi: 10.1093/eurheartj/ehy339.
  2. National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management (NG136). London: National Institute for Health and Care Excellence, August 2019.
  3. Wang N., Rueter P., Atkins E., et al. Efficacy and safety of low-dose triple and quadruple combination pills vs monotherapy, usual care, or placebo for the initial management of hypertension: a systematic review and meta-analysis. JAMA Cardiol. 2023;8(6):606–611. doi: 10.1001/jamacardio.2023.0720.
  4. Ettehad D., Emdin C.A., Kiran A., et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–967. doi: 10.1016/S0140-6736(15)01225-8.
  5. Groenland E.H., van Kleef M.E.A.M., Bots M.L., et al. Plasma trough concentrations of antihypertensive drugs for the assessment of treatment adherence: a meta-analysis. Hypertension. 2021;77(1):85–93. doi: 10.1161/HYPERTENSIONAHA.120.16061.
  6. Кобалава Ж.Д., Конради А.О., Недогода С.В., и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(9):6117. [Kobalava Zh.D., Konradi A.O., Nedogoda S.V., et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.)]. doi: 10.15829/1560-4071-2024-6117.
  7. Резник Е.В., Никитин И.Г. Новые рекомендации АСС/AHA и ESC/ESH по артериальной гипертонии. Кардиоваскулярная терапия и профилактика. 2018;17(5):99–119. [Reznik E.V., Nikitin I.G. New АСС/AHA and ESC/ESH arterial hypertension guidelines. Cardiovascular Therapy and Prevention. 2018;17(5):99–119. (In Russ.)]. doi: 10.15829/1728-8800-2018-5-99-119.
  8. Недогода С.В. Монотерапия артериальной гипертензии: конец главы или продолжение следует? Артериальная гипертензия. Consilium medicum. 2011;13(1):10–19. [Nedogoda S.V. Monotherapy of arterial hypertension: end of chapter or to be continued? Arterial hypertension. Consilium Medicum. 2011;13(1):10–19. (In Russ)].
  9. Реброва Е.В., Ших Е.В. Влияние инсерционно-делеционного полиморфизма гена ангиотензинпревращающего фермента на эффективность антигипертензивной терапии блокаторов рецептора ангиотензина II. Фармация и фармакология. 2023;11(6):494–508. [Rebrova E.V., Shikh E.V. Effect of insertion/deletion polymorphism of angiotensin-converting enzyme gene on efficacy of antihypertensive therapy with angiotensin II receptor blockers. Pharmacy & Pharmacology. 2023;11(6):494–508. (In Russ.)]. doi: 10.19163/2307-9266-2023-11-6-494-508.
  10. Реброва Е.В., Ших Е.В., Мелконян Г.Г., Кулагина Н.П., Соловьева С.А. Анализ ассоциаций полиморфных маркtров генов CYP2C9, AGTR1, AGT, ACE, CYP11B2 с достижением целевых цифр артериального давления у пациентов с впервые выявленной артериальной гипертензией I–II степени через 3 недели фармакотерапии блокаторами рецепторов ангиотензина II. Фарматека. 2024;9:40–45. [Rebrova E.V., Shikh E.V. Analysis of associations of polymorphic markers of the CYP2C9, AGTR1, AGT, ACE, CYP11B2 genes with the achievement of target blood pressure values in patients with newly diagnosed arterial hypertension 1-2 degree after 3 weeks of pharmacotherapy with angiotensin ii receptor blockers. Farmateka. 2024;9:40–45. (In Russ.)]. doi: 10.18565/pharmateca.2024.9.40-45.
  11. Реброва Е.В., Ших Е.В., Лазарева Н.Б. Влияние полиморфизма C-344T гена альдостерон синтазы на вариабельность антигипертензивной терапии блокаторами рецептора ангиотензина II: открытое рандомизированное контролируемое клиническое исследование. Фармация и фармакология. 2024;12(2):92–104. [Rebrova E.V., Shikh E.V., Lazareva N.B. Effect of C-344T polymorphism of aldosterone synthase gene on variability of antihypertensive therapy with angiotensin II receptor blockers: open randomized controlled clinical trial. Pharmacy & Pharmacology. 2024;12(2):92–104. (In Russ.)]. doi: 10.19163/2307-9266-2024-12-2-92-104.
  12. Реброва Е.В., Ших Е.В., Казаков Р.Е. и др. Анализ частоты встречаемости полиморфизмов генов CYP2C9, AGTR1, AGT, ACE, CYP11B2 у пациентов с впервые выявленной артериальной гипертензией I–II степеней. Фарматека. 2023;30(14):78–86. [Rebrova E.V., Shikh E.V., Kazakov R.E., et al. Analysis of the frequency of CYP2C9, AGTR1, AGT, ACE, CYP11B2 gene polymorphisms occurrence in patients with newly diagnosed 1–2 egree arterial hypertension. Farmateka. 2023;30(14):78–86. (In Russ.)]. doi: 10.18565/pharmateca.2023.14.78-86.
  13. Prasad P.P., Yeh C.M., Gurrieri P., et al. Pharmacokinetics of multiple doses of valsartan in patients with heart failure. J Cardiovasc Pharmacol. 2002;40(5):801–807. doi: 10.1097/00005344-200211000-00018.
  14. Puranajoti P., Werarak P., Intawong B., et al. Bioequivalence study of 300 mg irbesartan film-coated tablets preparations in healthy Thai volunteers. Thai Journal of Pharmaceutical Sciences. 2013;37:186–193. doi: 10.56808/3027-7922.2077.
  15. URL: https://www.ema.europa.eu/en/documents/assessment-report/irbesartan-teva-epar-public-assessment-report_en.pdf
  16. URL: https://www.geneesmiddeleninfor-matiebank.nl/pars/h112914.pdf
  17. Sandbaumhüter F.A., Haschke M., Vogt B., Bohlender J.M. Indexed plasma drug concentrations for drug adherence screening in hypertensive patients. Ann Cardiol Angeiol (Paris). 2018;67(3):119–126. doi: 10.1016/j.ancard.2018.04.020.
  18. Ritscher S., Hoyer M., Wunder C., et al. Evaluation of the dose-related concentration approach in therapeutic drug monitoring of diuretics and β-blockers - drug classes with low adherence in antihypertensive therapy. Sci Rep. 2019;9(1):15652. doi: 10.1038/s41598-019-52164-y.
  19. Garjón J., Saiz L.C., Azparren A., et al. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database Syst Rev. 2020;2(2):CD010316. doi: 10.1002/14651858.

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