Effectiveness of combined antihypertensive treatment depending on the phenomenon of salt sensitivity in patients with refractory arterial hypertension

Purpose of study - evaluate the effectiveness of combined antihypertensive treatmentthat includes direct renin inhibitor in salt-sensitive and salt-resistant patients with refractory hypertension (RHT).Methods and materials. The study included 192 patients with RHT. Based on the results of the V.I.Kharchenko test and a variation of combined antihypertensive therapy, all patients were randomized into groups: group 1 - salt-sensitive patients treated with an ACE inhibitor (ACEI), dihydropyridine calcium antagonist (CA), thiazide diuretic (TD) and direct renin inhibitor aliskiren (subgroup 1A) or b-blocker - BB (subgroup 1B); group 2 - salt-resistant patients treated with ACE inhibitors, dihydropyridine CA, TD and aliskiren (subgroup 2A) or BB (subgroup 2B). In the absence of achieving target BP after 6 weeks from the start of observation, patients started receiving five-component treatment: ACE inhibitor, CA, TD, BB and aliskiren. Initially and after 48 weeks of observation, all patients underwent ambulatory blood pressure monitoring (ABPM).Results. In the group of salt-sensitive patients treatment including aliskiren contributed to achievement of target values of BP in 43.3%, and with pre- scription of BB - in 54.3% of patients. In both groups there was a significant improvement in most of the parameters of ABPM, more pronounced when using BB. Normalization of circadian BP profile was registered significantly more often ( p <0.05) when using the BB than aliskiren treatment. In patients with salt resistance target BP level when using treatment that included aliskiren was recorded in 70.4% of cases, with prescription of BB - in 50% of patients. The use of aliskiren in these patients provided significantly greater improvement in the main indicators of ABPM and more frequent normalization of circadian BP profile than the therapy that included BB. Five-component treatment including aliskiren proved to be more effective in salt-resistant patients in both, frequency of reaching target BP and the dynamics of the main indicators of ABPM.Conclusion. In salt-sensitive patients the combination including BB as part of four-component treatment provided significant cumulative antihyper- tensive effect. In patients with salt resistance more effective was the use of aliskiren in comparison with the BB. The use of five-component treatment had certain advantages in salt-resistant patients.

refractory hypertension, salt sensitivity, salt resistance, direct renin inhibitor

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