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Abstract
The article presents the results of a clinical study of the effectiveness of the cytoprotective drug quercetin in the treatment of hypertension with the combined antihypertensive agent Ramipril/Amlodipine and its effect on the changes in blood pressure according to 24-hour BPM and endothelin-1. The aim of the study. To evaluate the effect of quercetin on the effectiveness of antihypertensive therapy in patients with stage 2 hypertension of 2-3 degrees based on the data of 24-hour blood pressure monitoring and the changes of endothelin-1 levels as an endothelial dysfunction marker. Materials and methods. 67 patients with stage 2 hypertension of 2-3 degrees (44 female and 23 male) were examined. Patients were divided into 2 groups: Group I (study) — 36 patients who took quercetin (Corvitin®) in addition to basic therapy, mean age 60.7±13.6 years; Group II (comparison) — 31 patients who underwent only basic antihypertensive therapy, mean age 59.9±14.6 years. Basic therapy involved the administration of the combined antihypertensive agent Ramipril/Amlodipine in individually adjusted doses: 5/5; 5/10; 10/5; 10/10, depending on the blood pressure of each patient. 24-hour BPM was performed and the endothelin-1 level was determined on admission and the 14th day. Results. At the end of the 14-day treatment period, in the settings of additional quercetin administration, the best indicators of achieving the target SBP values were found in 30 (83.3%) patients (group I). When only basic antihypertensive therapy was administered (group II), 22 (70.9%) patients reached the target SBP level. In group I, the mean daily levels of SBP and DBP decreased by 18.1% and 19.9%, in group II — by 8.2% and 10.5%, respectively. Moreover in group I, there was a significant decrease in the mean diurnal SBP by 20.61% (p<0.001) and the mean nocturnal SBP by 15.7% (p<0.001), the mean diurnal DBP by 16.2% (p<0.01) and the mean nocturnal DBP by 16.8% (p<0.01), and a more pronounced (p<0.01) decrease in the indicators of «pressure load», namely, SBP load — by 67%, DBP load — by 72.6% was detected compared to group II, where the decrease of SBP load by 57% and DBP load by 54% was found. Group I showed an increase in the number of patients with a normal daily SBP index (dipper) by
58.3%, group II managed to achieve normalization of dipping SBP by 48%, dipping DBP by 23.3% and 17%, respectively. The use of quercetin has a positive effect on endothelial function: a significant decrease in ET-1 by 21.4% (2.8±0.12 pg/ml; 2.2±0.1 pg/ml, p<0.001) in group I. In group II, there was a less pronounced decrease in this indicator — by 10.3% (2.71±0.2 pg/ml, 2.07±0.1 pg/ml, p<0.05). Improving the endothelial state contributes to better control of all blood pressure indicators. Conclusion. The administration of quercetin in patients with stage 2 hypertension of 2-3 degrees combined with the basic therapy using Ramipril/Amlodipine leads to more pronounced positive changes in the major indicators of 24-hour BPM (normalization of SBP, DBP, load, dipper) primarily due to increased endothelial vasodilator activity indicating a significant decrease in the ET-1 level in the group of additional cytoprotective therapy.