The analisis of factors, associated with office and home blood pressure control in patients who received algorithmic antihypertensive therapy

Юлія Володимирівна Руденко
2016 ScienceRise Medical Science  
АНАЛІЗ ЧИННИКІВ, ЩО АСОЦІЙОВАНІ З КОНТРОЛЕМ ОФІСНОГО І ДОМАШНЬОГО АРТЕРІАЛЬНОГО ТИСКУ В ПАЦІЄНТІВ, КОТРІ ОТРИМУЮТЬ АЛГОРИТМІЗОВАНУ АНТИГІПЕРТЕНЗИВНУ ТЕРАПІЮ © Ю. В. Руденко З досягненням цільового офісного АТ в пацієнтів з АГ через 6 місяців лікування асоціювались жіноча стать, рівень вихідного офісного САТ, відсутність потреби у 3-х препаратах через 7 днів лікування, високий комплаенс. З досягненням рекомендованого домашнього АТ через 6 місяців лікування асоціювались вік, жіноча стать, рівень
more » ... ихідного офісного САТ, високий комплаенс Ключові слова: артеріальна гіпертензія, артеріальний тиск, домашній артеріальний тиск, антигіпертензивне лікування, прихильність до лікування Aim. To define factors, associated with attaining control of the office and home AP and with the number of necessary medicaments in patients with non-complicated AH after 6 month of algorithmic antihypertensive therapy Materials and methods. 501 patients with AH received therapy according to the algorithm that provided successive prescription of fixed combination of perindopril, ampodipine and if necessary, indapamide-retard, spironolactone, moxonidine or doxazosin for attaining the target office AP. The office and home AP was assessed by certificated oscillometric devices. For determination of factors, independently associated with attaining the target level of office and recommended level of home AP after 6 months of therapy the multiple linear regressive analysis was used Results. After 6 months the office SAP and DAP decreased from 165,7±13,9 to 131,0±9,5 and from 96,9±9,7 to 79,3±7,1mm of m. c., home -from 148,8±15,7 to 129,4±8,3 and from 87,8±10,0 to 77,9±7,2 mm of m. c. After 6 months the target office AP was attained by 80,1 %, recommended home -by 65,8 % of patients. After 7 days indapamide-retard was added to the therapy in 24 % of patients. At the end of research 165 (37,2 %) patients were treated by three or more preparations. The high inclination to treatment was detected in 49, moderatein 43,6, low -in 7,4 % of patients Conclusions. The attainment of target office AP in patients with hypertension in 6 month of treatment was independently associated with female sex, age, initial level of office SAP, absence of the need in 3 preparations after 7 days of treatment, high compliance. The need of prescription of three and more preparations for AP control after 6 month was associated with low compliance, probable resistant AH before inclusion in the research, home SAP after 7 days and uncontrolled AH after 1 month of treatment Проведено оцінку ефективності збалансованої мультимодальної аналгезії (ЗММА): дексаметазон, декскетопрофен та білатеральна блокада поверхневого шийного сплетіння (ББПШС) та вплив ЗММА на частоту розвитку післяопераційної нудоти та блювання (ПОНБ). Продемонстровано високу аналгетичну ефективність комплексу ЗММА, оптимальна антиеметична схема є використання ЗММА із ББПШС на тлі базової анестезії пропофолом із додаванням метоклопраміду перед індукцією загальної анестезії Ключові слова: тиреотоксикоз, тиреоїдектомія, білатеральная блокада поверхневого шийного сплетіння, післяопераційна нудота та блювання Aim: the evaluation of antiemetic effect of bilateral blockage of superficial cervical plexus at the background of general anesthesia by sevoflurane or propofol in the complex of anesthesiology management of patients, who undergo thyroidectomy under conditions of specialized endocrinology center. Materials and methods. Patients are divided in 2 groups: the group of balanced analgesia (BA) -88 patients, control group 87 ones. Depending on the type of general anesthesia -inhalational by sevoflurane (S) or TIVA by propofol (P) patients were divided in subgroups BA-S -44 patients, BA-P -44 patients, C-S -46 patients and C-P -41 patients. In subgroups BA-S and BA-P was used the complex of balanced multimodal analgesia (BMMA) that included administration of dexamethasone, dekxketropofen and bilateral blockage of superficial cervical plexus (BBSCP) by 0,5 % solution of bupicavaine. The assessment of pain was carried out according to VAS, consumption of narcotic and non-narcotic analgetics, frequency and expressiveness of PONV during the first 24 hours of p/o period. Results and discussion. BMMA as BBSCP on the background of basic anesthesia by sevoflurane lowers the need and consumption of opioids, especially intraoperative consumption of fentanyl. Due to the high effectiveness of bilateral BSCP in subgroups of BA-S and BA-P it was not expedient to use the narcotic analgetics in p/o period as opposite to the groups C-S and C-P where they were used in 94,9 % and 93,7 % of patients respectively. According to VAS the pain in subgroups of 05) lower than in C-S and C-P. The use of BMMA on the background of basic anesthesia by sevoflurane in subgroup of BA-S provides intraoperative opioid-preserving action: the reliable (p<0,05) decrease of fentanyl consumption to 283,4±12,4 mcg for operation comparing with other subgroups. BMMA complex allowed reliably (p<0,05) raise the level of patients without PONV to 72,7 % and 77,3 % in subgroups of BA-S and BA-P respectively. The reliable decrease of the total sum of points according to PONV scale was attained in subgroup of BA-P to 0,36±0,11, that was by 60,6 % and 55,2 % less than in subgroups of C-S and C-P. For the subgroup of BA-S this index was 0, 41±0,11 and was by 55,4 % and 49,4 % reliably (p<0,05) less than in subgroups of C-S and C-P. Conclusions. The best antiemetic system is the use of BMMA with BBSCP on the background of basic anesthesia by propofol with addition of metoplocramide before the induction of general anesthesia: the index of patients without PONV -77,3 %, frequency of appearance of clinically significant PONV -9,1 %, index of general sum of points according to PONV scale -0,36±0,11 (all indices are reliably less than in subgroups of C-S and C-P)
doi:10.15587/2519-4798.2016.83696 fatcat:fuvwquyx7zdfndef4crhj6r4xe