Search

Aim. To prove the advantage of the long-term controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.Material and methods. It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped antihypertensive therapy based on ACE-inhibitor spirapril, the second one (control group) continued their usual standard therapy prescribed by doctors of polyclinics or other patient care institutions. The study lasted one year.Results. 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 – in the control group. 220 patients dropped out of the study by different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease in blood pressure in both group, but distinctions between systolic and diastolic blood pressure in the treatment and control group during the study were significant.The target levels of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequent in the patients of treatment group than in control group (69,4% и 39,3% after three months and 83,6% и 66,9% after 12 months of the treatment correspondingly).Conclusion. Controlled stepped antihypertensive therapy resulted into more significant decrease in systolic and diastolic blood pressure and more frequent achievement of target levels of blood pressure in comparison with control group. It supposes better prognosis of patients.

The paper describes a clinical case in which an 84-year-old patient with non-valvular atrial fibrillation (AF) who took dabigatran 110 mg twice a day developed recurrent ischemic stroke (IS) that caused dysarthria, left-sided hemiparesis, pain sensitivity and movement coordination impairments. At 170 minutes after IS development, idarucizumab was prescribed and thrombolytic therapy (TLT) was performed to neutralize the anticoagulant effect of dabigatran. At 24 hours after TLT, the National Institutes of Health Stroke Scale (NIHSS) scores were observed to decrease from 11 to 8; and repeated brain computed tomography revealed an ischemic focus in the left cerebellar hemisphere with hemorrhagic transformation to hemorrhagic heart attack type I. On day 19 of IS following the reversal of hemorrhagic transformation, dabigatran was resumed at a dose 110 mg twice a day.The described case, as well as other authors' data that reflect real clinical practice, confirms that the administration of idarucizumab is safe and allows TLT to be performed in patients with AF who develop IS while taking dabigatran.