Hakan ZENGİL, Mehmet YILDIZ, Mehmet CEYHAN

Sabah alınan perindopril/indapamid kombinasyonu,silazapril veya rilmenidinin gündüz ve gece döneminde kan basıncı kalp hızı parametrelerine etkisi

Amaç: Ambulatuvar kan basıncı monitörleri (AKBM) hipertansiyon tiplemesi dışında antihipertansif tedavilerin etkinliğini değerlendirmekte kullanılırlar. Bu çalışmada, sabah uygulanan perindopril/indapamid kombinasyonu (P/İ), silazapril veya rilmenidinin AKBM ile elde edilen kan basıncı ve kalp hızı parametrelerine etkileri karşılaştırılmıştır. Metodlar: Çalışmada, Dünya Sağlık Örgütü Kriterleri'ne göre evre I veya evre II olarak tanı konulmuş, beyaz önlük hipertansiyonu veya sınırda hipertansif olmayan, 31 esansiyel hipertansif hasta AKBM sonrasında çalışmaya dahil edilmiştir. Bu hastalar randomize olarak dağıtıldıkları üç grupta, sabah saatlerinde uygulanan silazapril (1 mg), P/İ (2 mg/0,625 mg) veya rilmenidin (1 mg) ile 10-12 hafta süreyle tedavi edildikten sonra yeniden AKBM ile değerlendirilmiş ve elde edilen veriler uygun metodlarla analiz edilmiştir. Bulgular: Silazapril ile P/İ kombinasyonu, 24 saatlik, gündüz ve gece dönemlerindeki SKB ve DKB ortalamalarını anlamlı olarak azaltırken, rilmenidin de gece SKB ortalaması dışındaki 24 saatlik ortalama ile gündüz ve gece ortalamalarını düşürmüştür. Silazapril ve P/İ kombinasyonu kalp hızını (KH) etkilemezken, rilmenidin tedavisi sonrasında anlamlı bradikardi saptanmıştır. Miyokardiyal oksijen alımı ve kalbin üzerindeki yükün indirekt göstergesi olan hız-basmç çarpımına (HBÇ) ilişkin çeşitli lineer ve ritim parametrelerim her üç ilaç da azaltmıştır. Sonuç: Uzun süreli kan basıncı izlenmesine olanak veren AKBM cihazları ile kişisel kan basıncı ve kalp hızı profillerinin belirlenmesi, tedavide kullanılacak ilaçların seçiminde belirleyici olabilir.

Effects of morning administered perindopril/idapamide combination cilazapril or rilmenidine on daytime and nightime blood pressure and heart rate parameters

Purpose: Ambulatory blood pressure monitoring (ABPM) devices are used to determine the circadian pattern of blood pressure as well as the efficacy of antihypertensive therapy. This study was designed to compare the effects of cilazapril, a perindopril/indapamide combination (P/I), or rilmenidine on 24- hour, daytime, and nighttime profiles of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) parameters obtained by ABPM. Methods: Thirty-one newly diagnosed, untreated essential hypertensive subjects who were not classified as white coat or borderline hypertension participated in the present study. The subjects were in stages I or II according to the WHO criteria. They were randomly assigned into three groups and were treated with cilazapril 1 mg (n = 10), a perindopril/indapamide combination (2 mg/0.625 mg respectively; n = 10), or rilmenidine 1 mg (n = 11) once daily in the morning for 10 or 12 weeks. The pre- and post-treatment monitor data were analyzed using appropriate methods. Results: All three drugs caused significant reductions in 24-hour, daytime, and nighttime means of SBP and DBP, except for nighttime SBP mean by rilmenidine. Significant reductions in Mesor (rhythm adjusted mean) values of both SBP and DBP were observed by rhythm analysis of ABPM data with morning administration of cilazapril, a perindopril/indapamide combination (P/I), and rilmenidine. Linear analysis of the data revealed* that cilazapril and the P/I combination did not change heart rate, but statistically significant bradycardia was observed after rilmenidine therapy. All three antihypertensives decreased several linear and rhythmic parameters of the rate-pressure product, which is regarded as an indirect measure of myocardial oxygen consumption and load on the heart. Conclusion: All three antihypertensive drugs used in this study reduced blood pressure effectively throughout the 24 h period. The only significant difference between their effects is the bradycardia observed after four weeks of therapy with rilmenidine. Knowledge of the individual blood pressure and heart rate profiles of patients with ABPM recordings will help in more effective antihypertensive treatments with less adverse effects.

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