Pharmacological approaches to the correction of autonomic dysfunction in patients with hypertension

Hypertension is a major contributor to global cardiovascular morbidity and mortality. The autonomic nervous system is essential to homeostasis, and its dysfunction, present in 65—85% of hypertension cases, contributes to cognitive and psycho-autonomic disorders. Objective. To assess the efficacy and safety of sequential therapy with ethyl methylhydroxypyridine succinate (Mexidol, solution for injections and 125 mg tablets) in patients with autonomic dysfunction associated with hypertension. Materials and methods. This prospective, open-label, comparative study enrolled 60 patients aged 40 to 59 years with stage I—II hypertension and autonomic dysfunction (A.M. Vein score >15). The main group (n=30) received standard antihypertensive therapy plus ethyl methylhydroxypyridine succinate, administered intramuscularly for 10 days at 4.0 mL (200 mg), followed by oral administration of 125 mg three times daily for 8 weeks. The control group (n=30) received only standard therapy. Assessments included the A.M. Vein scale, Schulte test, Digital Symbol Substitution Test (DSST), 5-word test, Hospital Anxiety and Depression Scale (HADS), and Clinical Global Impression (CGI). Results. The main group exhibited a statistically significant reduction in the A.M. Vein score by the second visit (p<0.001), followed by further reduction at the third visit (p<0.001). Significant improvements in executive function, as measured by the DSST (p<0.001), and in early memory consolidation, as assessed by the 5-word test (p<0.001), were observed. The HADS scale demonstrated a pronounced anxiolytic and antidepressant effect (p<0.001). According to the CGI scale, improvement at the end of follow-up was observed in 69.5% of patients in the main group, compared to 0% in the control group (p<0.001). Conclusions. Sequential therapy with ethyl methylhydroxypyridine succinate (solution and tablets) is an effective and safe strategy for correcting autonomic, cognitive, and affective disorders in patients with hypertension and autonomic dysfunction.