THERAPY OF ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC PAIN SYNDROME ASSOCIATED WITH DORSOPATHY

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VI. Relevance

Clinical practice shows that about 90% of all diseases are associated with pain syndrome [1, 5]. According to domestic studies, from 7% to 64% of the population periodically experience pain, and from 7.6% to 45% suffer from recurrent or chronic pain. More than 60% of patients regularly take analgesics: every third (32.2%) - daily, another 30.2% of patients - several times a week. Dorsopathy is one of the most common pathologies in clinical practice in middle-aged and elderly people [1, 4.5]. At the same time, with age, the proportion of patients with chronic back pain syndrome increases. Along with this, the risk of developing arterial hypertension increases, especially with the use of NSAIDs [2, 4]. Thus, in patients with chronic pain syndrome, hypertension is observed almost 2 times more often (39%) than in patients without chronic pain syndrome (21%) [6]. This pathological condition significantly complicates professional and social activity, reducing the ability to work and the quality of life. Treatment of comorbid pathology is a complex clinical task, therefore, the most promising combination of antihypertensive drugs will be [3] .

VII. AIM- to determine the features of the treatment of arterial hypertension in patients with chronic pain syndrome associated with dorsopathy in real clinical practice.

VIII. MATERIALS AND METHODS

A retrospective analysis of 85 case histories of patients of the neurological department of the ChUZ Clinical Hospital "Russian Railways-Medicine" of the city of Voronezh "hospitalized in 2019-2020 was carried out. The criterion for inclusion in the sample was the presence of comorbidity in the patient, including arterial hypertension (AH) and chronic pain syndrome (CHD) against the background of dorsopathy. For each patient, an individual card of pharmacotherapy was compiled with an indication of the drug, dosage regimen, duration of admission, as well as an analysis of complaints, data from laboratory and instrumental studies. Statistical processing was carried out using the Microsoft Excel 2010.VIII computer program.

IX. RESULTS

The objects of the study were the case histories of patients in the neurological department of the Clinical Hospital RZD-Medicine, Voronezh.

Hypertension and chronic pain syndrome were observed in all patients, and the structure of the main diagnosis was dominated by muscle-tonic syndrome, which was in 74% of patients. In terms of the severity of the course of hypertension, the most common was the second stage - in 67.7% of patients.

Among the studied by gender, women predominated (64.5%); by age, all patients were in the group from 44 to 65 years old. The average body mass index in the study group was 29.8 ± 2.5 kg / m2, which corresponded to the presence of overweight.

When evaluating laboratory data, it was found that more than half of the patients (51.6%) were susceptible to hypercholesterolemia, hyperglycemia was detected in 35.5% of patients.

When evaluating the characteristics of the treatment of arterial hypertension, it was noted that monotherapy to reduce hypertension was noted in 32.2% of patients, and most of the patients in this group took ACE inhibitors (enalapril, lisinopril, perindopril).

Combined therapy of two antihypertensive drugs to reduce blood pressure was in 38.7% of patients, among whom in half of the cases there was a combination of a thiazide diuretic and an ACE inhibitor. Most often, for the treatment of hypertension, a combination of the diuretic indapamide 2.5 mg in the morning + a drug from the ACE inhibitor group was prescribed (enalapril 5 mg 2 r / day or perindopril 5 mg 1 r / day or lisinopril - 10 mg 1 r / day).

Other options of the therapy with two antihypertensive drugs included a combination of BAB + ACE inhibitors (16.6% of patients), TD + antagonists of imidazoline receptors (AIR), TD + BAB, ACE inhibitors + AIR (8.3% of patients).

Pharmacotherapy of three antihypertensive drugs was taken by 29, 1% of patients who most often have a combination of BAB + TD + ACE inhibitors. An alternative regimen was a combination of ACE inhibitors + TD + AIR.

Among the observed group of patients with hypertension and chronic pain syndrome, the prescription of CCBs was established only in 3.5% of patients, which indicates a low adherence to the choice of this group of drugs.

X. DISCUSSION

The obtained data indicate that the majority of patients for the treatment of hypertension associated with CHD receive combined pharmacotherapy, and the combination of TD + ACE inhibitors was observed in half of the cases from this group. When three drugs were prescribed to lower blood pressure, the most frequently prescribed combination was a combination of BAB + TD + ACE inhibitors. Monotherapy for hypertension was encountered in clinical practice in one third of patients, and most of the patients were prescribed ACE inhibitors (enalapril, perindopril, lisinopril).

It is known that drugs of the ACE inhibitor group have many positive properties [3]: due to the cancellation of the transition of angiotensin I to angiotensin II, a hypotensive effect is observed. Angiotensin-converting enzyme inhibitors reduce the activity of AT II, ​​which makes it possible to slow down the progression of left ventricular dysfunction and the further development of CHF; ACE inhibitors reduce the total peripheral vascular resistance and reduce the incidence of cardiac arrhythmias; in addition, there was a positive effect of ACE inhibitors on lipid, carbohydrate and purine metabolism, as well as on regional blood flow. Probably, all of the above properties of this class of drugs determined the predominant use of ACE inhibitors as an antihypertensive agent, since the study established their appointment in the overwhelming number of patients (64.5%), and the most commonly used combinations of two or three antihypertensive drugs often included ACE inhibitors.

The ongoing pharmacotherapy of hypertension corresponds to the Russian clinical guidelines for the treatment of hypertension (2019), but did not take into account the peculiarities of the pathogenesis of an increase in blood pressure against the background of chronic heart disease in dorsopathy, the need to take NSAIDs that increase the risk of hypertension [6, 7]. In this case, the drug of choice should be CCBs, the intake of which does not depend on the effect of NSAIDs on prostaglandin synthesis and renal blood flow. Correction of the pharmacotherapy of hypertension in patients with chronic pain syndrome should be carried out both in monotherapy and in combination therapy.

X. CONCLUSION

An analysis of the pharmacotherapy of arterial hypertension in patients with chronic pain syndrome associated with dorsopathy was carried out. The most common antihypertensive therapy is a combination of two drugs, the drug of choice in real clinical practice is the combination of TD + ACE inhibitors. In one third of the studied patients, monotherapy was prescribed, also predominantly with the use of an ACE inhibitor. During therapy with a combination of three drugs for lowering blood pressure, several variants of the combination of drugs were identified, including BAB + TD + ACE inhibitors or ACE inhibitors + TD + AIR. In clinical practice, the limited use of CCBs has been established, which indicates the need to correct the ongoing pharmacotherapy.

About the authors

Yulia V. Khodarina

Воронежский государственный медицинский университет

Author for correspondence.
Email: hodarina@list.ru
ORCID iD: 0000-0001-6513-7735
SPIN-code: 6314-6062
Russian Federation

Elvira Sh. Kartashova

ВГМУ им. Н.Н. Бурденко

Email: elvira.imanova@mail.ru
ORCID iD: 0000-0002-8595-9805
SPIN-code: 3601-9077

Maria E. Margulis

ВГМУ им. Н.Н. Бурденко

Email: maria.margulis@ya.ru
ORCID iD: 0000-0001-8740-307X
SPIN-code: 8846-2316

References