Antihypertensive and vasoprotective efficacy of combined chronopharmacotherapy in patients with arterial hypertension who have experienced a transient ischemic attack

Objective. To determine the influence of different daily administration regimens of azilsartan medoxomil and nitrendipine on the main parameters of 24‑hour blood pressure monitoring, central hemodynamics, and vascular wall stiffness in patients with arterial hypertension who have experienced a transient ischemic attack.

Materials and methods. The study included 80 patients: 30 men and 50 women, with a mean age of 60,18±11,59 years. 24‑hour ambulatory blood pressure monitoring (ABPM) was performed before and after 24 weeks of treatment, with assessment of the main ABPM parameters. Patients were randomly assigned to 2 groups depending on the regimen of combined antihypertensive chronopharmacotherapy: Group 1 (n=40): patients receiving azilsartan medoxomil at a starting dose of 40 mg in the morning and nitrendipine 10 mg in the morning and evening; Group 2 (n=40): patients receiving azilsartan medoxomil at a starting dose of 40 mg in the evening, also with twice‑daily administration of nitrendipine 10 mg.

Results. After 24 weeks, with dose adjustments of the medications used, target blood pressure levels were achieved in 95 % of cases (38 patients) in Group 1 and 97.5 % (39 patients) in Group 2. After 24 weeks of treatment, in patients who achieved target blood pressure levels, both groups showed a statistically significant improvement (p<0,05) in ABPM parameters, central blood pressure (CBP), and arterial stiffness. However, the degree of change varied depending on the prescribed therapy regimen. Administration of azilsartan medoxomil in the evening with twice‑daily nitrendipine intake provided a statistically more significant reduction in mean daytime and nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as SBP and DBP variability during daytime and nighttime hours. Additionally, a more pronounced improvement in vascular stiffness parameters and central hemodynamics was observed compared to morning administration of azilsartan medoxomil.

Conclusion. In patients with arterial hypertension (AH) who have experienced a transient ischemic attack (TIA), evening administration of azilsartan medoxomil together with twice‑daily intake of the calcium channel blocker (CCB) nitrendipine provided a more pronounced antihypertensive and vasoprotective effect than morning administration of the angiotensin II receptor blocker. Thus, a chronotherapeutic approach may enhance treatment efficacy in this patient population and, potentially, reduce the risk of recurrent cerebrovascular complications in the future.

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