Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Neurology

Background:

• Arterial hypertension (AH) is a significant risk factor for cerebrovascular accidents like transient ischemic attack (TIA) and ischemic stroke (IS).
• Optimizing antihypertensive therapy is crucial for managing AH and preventing recurrent vascular events.

Purpose of the Study:

• To assess the effectiveness of combined antihypertensive chronopharmacotherapy in patients with AH post-TIA or IS.
• To evaluate the impact on daily blood pressure profile, vascular wall stiffness, and central aortic pressure.

Main Methods:

• 235 hypertensive patients post-TIA (n=116) or IS (n=119) were randomized into four groups.
• Groups received either morning-only or twice-daily indapamide retard 1.5 mg and valsartan (160 mg or 80 mg BID).
• Ambulatory blood pressure monitoring (ABPM), central aortic pressure (CAP), and vascular stiffness were assessed at baseline and after 12 months.

Main Results:

• Twice-daily valsartan significantly improved blood pressure control and vascular parameters compared to morning-only dosing.
• All treatment groups showed positive dynamics in ABPM, vascular stiffness, and CAP.
• Patients with IS receiving twice-daily valsartan showed greater improvements than TIA patients on the same regimen.

Conclusions:

• Combined antihypertensive chronopharmacotherapy with twice-daily valsartan and indapamide is superior to morning-only dosing for achieving target blood pressure.
• This regimen significantly improves ABPM, vascular stiffness, and central aortic pressure in patients with AH post-TIA or IS.