Effectiveness of chronopharmacotherapy in salt-sensitive and salt-resistant patients with chronic heart failure and preserved ejection fraction

The aim of the study was to evaluate the influence of chronopharmacotherapy on the indices of the structural and functional state of the left ventricular myocardium in patients with arterial hypertension (AH), type 2 diabetes mellitus and heart failure with preserved ejection fraction (HFpEF) considering of salt-sensitivity. Included 130 patients with uncontrolled AH, type 2 diabetes and HFpEF (81 women and 49 men), median age - 59 (38-72) years. Patients were divided into 2 groups: saltsensitive (group 1) and salt-resistant (group 2), and then randomized to 2 subgroups depending on the treatment option: morning ramipril and indapamide retard, in the evening amlodipine (subgroup 1A and 2A) or in the evening ramipril, in the morning indapamide-retard and amlodipine (subgroup 1B and 2B). Initially and after 24 weeks of antihypertensive therapy, an echocardiographic study was carried out with an assessment of the main indicators of the structural and functional state of the left ventricular (LV) myocardium, a 6-minute walk test for determining the functional state of patients. After 24 weeks in all subgroups there was a reliable positive dynamics of echocardiographic indicators. In the group of salt-sensitive patients, the reception of the angiotensin converting enzyme inhibitor (ACE inhibitor) in the evening and thiazide diuretic (TD) + calcium antagonists (AC) in the morning provided a signifcantly more signifcant reduction in the majority of LV myocardial remodeling parameters compared with the administration of ACE inhibitor + TD in the morning and AK in the evening. In the case of salt-resistant patients, comparable positive changes in echocardiographic indicators were noted against the background of both dosing regimens during the day. Against the background of the treatment, irrespective of the salt sensitivity and dosing regimen, an unreliable and comparable increase in the distance of the 6-minute walk test was recorded during the day. In salt-sensitive patients with AH, type 2 diabetes and HFpEF, the use of ACE inhibitor before bedtime provided signifcantly more signifcant regression of the parameters of the structural and functional state of LV myocardium compared with the morning reception. In the group of salt-resistant patients, the efcacy of both dosing regimens during the day was comparable.