A METHOD OF DIFFERENTIAL TREATMENT AND SECONDARY PREVENTION OF TARGET ORGANS AFFECTION OF PATIENTS WITH HYPERTENSIVE HEART DISEASE AND WITH 2 TYPE DIABETES

摘要

A method of differential treatment and secondary prevention of target organs affection of patients with hypertensive heart disease and with 2 type diabetes, which provides the pre-treatment determination of anthropometric, biochemical, echocardiographic rates determined together with the presence and severity of microalbuminuria (MAU) by urinary albumin excretion as a predictor of early target organ damage, according to survey data it is performed a stratification of a risk of development of cardiovascular events for the next 10 years and it is prescribed as part of basic therapy of pathology a different combinations of antihypertensive drugs of the 1st line with cardio- and renoprotective properties.In case of the presence of a high and very high risk of cardiovascular events of patients additionally are defined an individual 4-year risk of cardiovascular events and the concentration of endogenous peptides - apelin in blood serum, it is implemented a combined quantitative assessment of the level of albumin excretion with urine (MAU) and the concentration of apelin in blood serum and if in a group of high/very high risk of cardiovascular events is specified an individual 4-year risk of cardiovascular events less than 8%, and the level of albumin excretion with urine (MAU) does not exceed 100±7,2 microgram/ml, and apelin concentration in blood serum is reduced at least by 10% comparatively with the norm, as a rational combination of antihypertensive drugs are prescribed angiotensin II receptor blocker (ARB II), such as olmesartan, and the calcium antagonist (CA) of the III generation, such as lercanidipine, and if in a group of high/very high risk of cardiovascular events is specified an individual 4-year risk of cardiovascular events more than 8%, and the level of albumin excretion with urine (MAU) exceeds 100±7,2 microgram/ml, and apelin concentration in blood serum is reduced more than by 10% comparatively with the norm, in this case to the mentioned combination of antihypertensive drug is added a highly selective beta-blocker with NO-liberating abilities, such as nebivolol, moreover antihypertensive drugs are prescribed in a therapeutically effective and safe dosage for 12 weeks.