CARDIOPROTECTIVE EFFICACY OF ANTIHYPERTENSIVE THERAPY INCLUDING SPIRONOLACTONE AND EPLERENONE IN PATIENTS WITH ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION

Objective: to perform a comparative analysis of antihypertensive therapy (AHT) effectiveness including eplerenone and spironolactone in patients with arterial hypertension (AH) complicated by atrial fibrillation (AF). Design and method: The study included 99 male and female patients with AH complicated by a permanent form of AF. The average age of patients was 61.3±9.5 years, the average duration of AH was 12.9±8.3 years. ECG Holter monitoring was performed using a Cardiospy monitor (LABTECH LTD, Hungary) to verify AF. Echocardiographic examination was carried out in accordance with the recommendations of the American Association of Echocardiography in M- and B-modes. Statistical processing of the results was carried out in the Microsoft Excel 2010 database using the Statistica 10.0 program. The results of all studies were accepted as statistically significant at a p value of <0.05. Results: 99 patients were divided into 2 groups: 1st group – patients who completed a 6-month combined AHT with the inclusion of spironolactone (n=51) and 2nd group– patients who completed a 6-month combined AHT with the inclusion of eplerenone (n=48). Analysis of office blood pressure indicators showed good 6-month antihypertensive effectiveness in both groups, regardless of the treatment regimen. Cardioprotective efficacy was noted in the 2nd group of patients. Specifically, a significant improvement in the left ventricular ejection fraction (LVEF) was observed compared to 1st group: initially in 1st group LVEF was 55.4 ± 10.6%, after treatment– 52.6 ± 9.1% (p>0.05); in 2nd group LVEF improved from 54.8±8.8% to 58.2±6.4% (p<0.02). In group 2, the indexed left atrium volume (ILAV) significantly decreased compared to group 1. Specifically, in group 1, ILAV was 42.2±15.1 ml/m2before treatment and 40.4±12.2 ml/m2after treatment (p>0.05). In group 2, ILAV decreased from 41.2±15.3 ml/m2to 37.3±13.5 ml/m2(p<0.05). The percentage change in ILAV (δ%ILAV) was -5.9% in the eplerenone group compared to -0.36% in the spironolactone group. Conclusions: The advantages of cardioprotection with combined AHT including eplerenone were demonstrated in patients with AH complicated by AF. In this group, AHT significantly improved LVEF and reduced ILAV compared to therapy containing spironolacton.