Dynamics of platelet hemostasis indicators in different blood pressure profiles in elderly and middle-aged hypertensive patients under combined antihypertensive treatment
Authors: Pasko Viktoriia 
Published: January 2025

In addition to achieving target blood pressure levels an equally important task is risk stratification of probable thrombotic complications in arterial hypertension in the elderly. This is reflected in the updated recommendations for implementing elderly patients with arterial hypertension. Studies of platelet activation in patients with arterial hypertension provide the implementation basis of new approaches to pharmacological prevention of complications associated with increased thrombus formation. Antihypertensive drugs have different effects on hemostasis parameters, which requires further study. Thus, this article attempts to systematise and analyse some literature data on the standard antihypertensive drugs effect. The purpose was to conduct a comparative assessment of the platelet hemostasis parameters dynamics in elderly and middle-aged hypertensive patients depending on the daily rhythm of blood pressure under combined antihypertensive treatment with enalapril and amlodipine. The work is based on the special examination of 93 elderly and 127 middle-aged hypertensive patients who were on inpatient two-week treatment. The state of spontaneous and induced platelet aggregation was determined. When analysing induced platelet aggregation a significant prolongation of time of maximal aggregation from 3.3 ± 0.9 min to 9.3 ± 0.4 min in elderly hypertensive patients with amlodipine treatment is noteworthy (p<0.05). Analysing the indicators of spontaneous platelet aggregation in elderly and middle-aged patients under combined treatment of the dipper group we established a significant decrease (p <0.05) in the amplitude of spontaneous platelet aggregation by 32% and 28%. The analysis of indicators of spontaneous aggregation of platelets showed that in the group of elderly patients of the non-dipper group, spontaneous aggregation slowed down according to the slope by 66.7% (p<0.05). Analysing the indicators of induced platelet aggregation in the elderly dipper group aggregation slope with ADP-inducer was slowed down by 37.6% (p<0.05). With insufficient nocturnal blood pressure reduction in middle-aged hypertensive patients aggregation amplitude during ADP-initiated platelet aggregation significantly decreased by 29.9% (p <0.05). There was a significant acceleration of the aggregation slope by 63.6% (p <0.05) during adrenaline-stimulated aggregation. It can be concluded that the effect of combined treatment with enalapril and amlodipine on platelet hemostasis in elderly patients depends on the initial blood pressure profile. Thus, all this confirms the reduction of thrombogenic potential in elderly patients in the dipper group under combined antihypertensive treatment with enalapril and amlodipine. Among elderly hypertensive patients according to blood pressure profile, the non-dipper group should be considered due to their involvement in a high-risk group for thrombotic events.

Keywords: arterial hypertension; essential hypertension; platelet aggregation; elderly and middle-aged hypertensive patients