Introduction. Gout remains the most common type of inflammatory arthritis worldwide. Indicators of prevalence and incidence of gout are growing especially in the young working age. In addition, the prevalence of hyperuricemia in the world is 25.0%. The most common comorbid disease in gout is hypertension (HT) [1].
A long-term increase in systolic blood pressure increases the risk of developing heart failure, damage to brain vessels and chronic kidney disease [2]. Achieving target blood pressure levels remains a challenge in clinical practice.
The purpose of the study is to evaluate the effectiveness of basic therapy drugs for the treatment of patients with hypertension in combination with gout on quality of life indicators.
Materials and methods. The diagnosis of hypertension was established in accordance with the recommendations of the Ukrainian Association of Cardiology, the European Association of Hypertension, and the European Association of Cardiology in 2018. [3]. The diagnosis of gout was established according to the ACR and EULAR criteria of 2015 [4].
Quality of life was assessed using the SF-36 standardized questionnaire, which assesses the patient's subjective satisfaction with his physical and mental state. The first group received losartan at a dose of 50-100 mg per day, depending on the degree of hypertension. The second group received ramipril 2.5-10 mg per day, depending on the degree of hypertension. All patients with gout in remission were prescribed allopurinol at a starting dose of 100 mg per day, followed by dose titration until reaching the target blood uric acid level <360.0 μmol/l, colchicine 0.5 mg per day for 6 months to prevent exacerbations, atorvastatin 20 mg per day followed by dose titration to achieve the target level of low-density lipoprotein cholesterol.
The results. Before the start of treatment, no statistically significant differences were found between the groups in terms of gender, age, blood pressure level, stage and degree of hypertension, clinical characteristics of gout, form of arthritis.
Patients in both groups had reduced indicators of the physical component of health (PCH) and the psychological component of health (PsCH) on the SF-36 scale before treatment, no significant difference was found between the groups on the scales of the SF-36 questionnaire before the appointment of treatment.
According to the results of the analysis, it was established that the level of quality of life increased according to the PCH indicator by 27.7% in the first group and by 20.4% in the second group (p<0.01), according to the PsCH indicator by 18.4% and 17.5% (p<0.01), respectively. In particular, an increase in quality of life indicators was observed on the scale of the role of physical problems in limiting life activities by 33.3% in the losartan group (p<0.01) and by 60.0% in the ramipril group (p<0.01); according to the pain scale – by 60.9% (p<0.01) and 39.7% (p<0.01), respectively; on the general health scale – by 10.0% (p<0.01) and 17.9% (p<0.01).
There was an improvement in the vital activity scale by 22.5% when taking losartan (p<0.01) and by 15.8% when taking ramipril (p<0.01); social activity by 20.0% and 50.0%, respectively (p<0.01); the role of emotional problems in limiting life activities by 2.0 times (p<0.01) in both groups. Mental health indicators increased by 50.0% in both groups of patients (p<0.01).
Conclusion. The appointment of losartan or ramipril for 6 months is accompanied by a significant improvement in the quality of life of patients according to the indicators of PCH (25.1%, p<0.01) and PsCH (17.7%, p<0.01). It is necessary to take into account all aspects of the effect of drugs on blood pressure, blood uric acid, lipid metabolism, as well as the presence of numerous concomitant diseases.
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1.Bevis M, Blagojevic-Bucknall M, Mallen C, Hider S, Roddy E. Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. Rheumatology (Oxford). 2018 Aug 1;57(8):1358-63. doi: 10.1093/rheumatology/key096.
2.Malta DC, Goncalves RPF, Machado IE, Freitas MIF, Azeredo C, Szwarcwald CL. Prevalence of arterial hypertension according to different diagnostic criteria, National Health Survey. Rev Bras Epidemiol. 2018 Nov 29;21(suppl 1):e180021. doi: 10.1590/1980-549720180021.supl.1.
3.Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339.
4.Janssens HJEM, Fransen J, Janssen M, Neogi T, Schumacher HR, Jansen TL, et al. Performance of the 2015 ACR-EULAR classification criteria for gout in a primary care population presenting with monoarthritis. Rheumatology (Oxford). 2017 Aug 1;56(8):1335-41. doi: 10.1093/rheumatology/kex164.
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