ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 27 of 67
УЖМБС 2020, 5(3): 208–214
Clinical Medicine

Efficiency of Application of Various Treatment Schemes in Patients with Coronary Artery Disease and Hypertension with Type 2 Diabetes Mellitus

Мolotiagin D.

The main direction of drug therapy to prevent coronary complications in patients with coronary artery disease with concomitant type 2 diabetes mellitus is the correction of risk factors – hypertension, dyslipidemia, hyperglycemia, and insulin resistance. Angiotensin II receptor antagonists (ARA II) are first-line drugs in the treatment of hypertension in patients with type 2 diabetes mellitus and have unique metabolic effects on the effects on carbohydrate and lipid metabolism. The purpose of the study was to evaluate the efficiency of the different types of treatment for patients with coronary artery disease, hypertension and type 2 diabetes mellitus by determining the dynamics of the studied parameters. Material and methods. A comprehensive examination of 110 patients with coronary artery disease was carried out. Patients were divided into groups depending on the presence of type 2 DM. The first group included 75 patients with stable coronary artery disease, hypertension and type 2 diabetes mellitus, the comparison group consisted of 35 patients with coronary artery disease and hypertension without type 2 diabetes mellitus. The parameters of cardiohaemodynamics were measured for all patients, general clinical and instrumental examinations were performed. Results and discussion. The treatment in both subgroups led to a decrease in blood pressure, both systolic and diastolic; contributed to benign left ventricle remodeling; also it led to improvement in diastolic function and had an expressive therapeutic effect in relation to lipid profile indicators. A comparative analysis of various therapeutic regimens using probably showed an improvement in diastolic function due to an increase in the E/A ratio in the 2nd subgroup after treatment compared with the 1st subgroup (p<0.05). Conclusion. The use of valsartan and telmisartan in the treatment of coronary artery disease and hypertension in patients with type 2 diabetes mellitus contributed to the correction of clinical features, lipid metabolism indexes (high-density lipoprotein levels increased by 51.64% and 57.14%; triglyceride levels decreased by 25.97% and 28.73%, low density lipoproteins – by 21.36% and 22.66%, total cholesterol – by 21.0% and 20.62%, very low density lipoproteins – by 56.68% and 53.51% respectively), suppression of the immunoinflammatory process (decreased pentraxin-3 by 32.15% and 33.0%), increased myocardial capacity to reduce by 12.93% and 15.89%, decreased measures of the left ventricle and its cavity (p <0.05). A comparative analysis of using various treatment regimens demonstrated the advantage of therapy with valsartan only on the ratio of E/A. No significant differences were found in other indicators, which indicates the equal efficiency of the proposed treatment regimens in patients with coronary artery disease and hypertension with type 2 diabetes mellitus.

Keywords: coronary artery disease, hypertension, type 2 diabetes mellitus, valsartan, telmisartan

Full text: PDF (Ukr) 214K

  1. American Diabetes Association: Clinical practice recommendations 2019. Diabetes Care. 2019; 29 (1): 1-85.
  2. Leonova MV. Klynycheskaya farmakologyya antagonystov retseptorov AT II: osobennosty valsartana [Clinical pharmacology of AT II receptor antagonists: features of valsartan]. Medytsynskyy sovet. 2014; 17: 66-72. [Russian]
  3. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007; 369(9557): 201-7.
  4. Radchenko AD. Nuzhny ly spory na temu: luchshe sartany yly yngybytory APF? (Chast 1) [Do you need a debate on the topic: better sartans or ACE inhibitors? (Part 1)]. Arteryalnaya gypertenzyya. 2014; 2(34): 97-111. [Russian]
  5. Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer M-J, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text‡: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007 Jun; 9(Suppl_C): C3-C74.
  6. Satirapoj B, Leelasiri K, Supasyndh O, Choovichian P. Short-term administration of an angiotensin II receptor blocker in patients with long-term hemodialysis patients improves insulin resistance. J Med Assoc Thai. 2014; 97(6): 574-81.
  7. Messerli F. Antihypertensive Efficacy of Hydrochlorothiazide as Evaluated by Ambulatory Blood Pressure Monitoring. A meta-analysis of randomized trial. Am Coll Cardiol. 2011; 57: 590-600.
  8. Hannon O, Laroche P, Vidal JS, Pannier B, Postel-Vinay N, Vaisse B, et al. Assessment of antihypertensive monotherapies effectiveness by home blood pressure self-measurement in hypertensive patients. Ann Cardiol Angeiol (Paris). 2012; 61(3): 218-23. [French]
  9. Calvo C, Hermida RC, Ayala DE, Ruilope LM. Effects of telmisartan 80 mg and valsartan 160 mg on ambulatory blood pressure in patients with essential hypertension. J Hypertens. 2004; 22(4): 837-46.
  10. Littlejohn T, Mroczek W, Marbury T, VanderMaelen CP, Dubiel RF. A prospective, randomized, open-label trial comparing telmisartan 80 mg with valsartan 80 mg in patients with mild to moderate hypertension using ambulatory blood pressure monitoring. Can J Cardiol. 2000; 16: 1123-32.
  11. White WB, Lacourciere Y, Davidai G. Effects of the angiotensin II receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure: impact on the early morning period. Am J Hypertens. 2004; 17: 347-53.
  12. Nixon RM, Muller E, Lowy A, Falvey H. Valsartan vs. оther angiotensin II receptor blockers in the treatment of hypertension: a meta-analytical approach. Int J Clin Pract. 2009; 63(5): 766-75.
  13. Abraham I, MacDonald K, Hermans C, Aerts A, Lee C, Brié H, et al. Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program. Vasc Health Risk Manag. 2011; 7: 209-35.
  14. Gillespie EL, White CM, Kardas M, Lindberg M, Coleman CI. The impact of ACE inhibitors or angiotensin II type 1 receptor blockers on the development of new-onset type 2 diabetes. Diabetes Care. 2005; 28(9): 2261-6.
  15. González-Ortiz M, Mora-Martínez JM, Martínez-Abundis E, Balcázar-Muñoz BR. Effect of valsartan on renal handling of uric acid in healthy subjects. J Nephrol. 2000; 13(2): 126-8.