Integrated management of a polymorbid patient with hypertension and coronary artery disease: A case report and literature review
https://doi.org/10.21518/ms2026-166
Abstract
Arterial hypertension (AH) remains a leading risk factor for cardiovascular complications and cognitive impairment. Effective control of blood pressure (BP) significantly reduces the risk of stroke and coronary artery disease (CAD). However, in real-world clinical practice, achieving target BP levels is often complicated by comorbidities, poor treatment adherence, and neglect of the circadian BP profile, particularly morning BP surges, which are an independent predictor of cardiovascular events. Among antihypertensive drugs, angiotensin II receptor blockers (ARBs) hold a special place due to their proven cerebroprotective effects. Candesartan, one of the most extensively studied representatives of this class, not only effectively lowers BP but also slows the progression of cognitive impairment and significantly reduces the risk of stroke. The presented clinical case demonstrates the potential for treatment optimization in a patient with long-term uncontrolled AH, CAD, obesity, and established cognitive impairment. Given the presence of morning BP surges and cognitive dysfunction, the patient was prescribed candesartan 16 mg/day in combination with bisoprolol, indapamide, and atorvastatin. For secondary prevention of thrombotic complications, acetylsalicylic acid (ASA) combined with magnesium hydroxide was chosen, which preserves the high bioavailability of the immediate-release ASA formulation while simultaneously providing gastric mucosal protection. After 9 months of therapy, target BP levels were achieved, morning BP surges were eliminated, and improvements in cognitive function and regression of left ventricular hypertrophy were observed. Thus, candesartan, due to its cerebroprotective properties and ultra-long duration of action, is the drug of choice in comorbid patients with AH and cognitive impairment. The combination of ASA with magnesium hydroxide provides an optimal balance of antiplatelet efficacy and gastroprotection.
About the Authors
O. D. Ostroumova
Russian Medical Academy of Continuous Professional Education;
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Olga D. Ostroumova, Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology named after Academician M. S. Vovsi, Russian Medical Academy of Continuous Professional Education; Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases of the Sechenov First Moscow State Medical University (Sechenov University)
2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993;
8, Bldg. 2, Trubetskaya St., Moscow, 119048
S. S. Telkova
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Svetlana S. Telkova, Postgraduate Student, Senior Assistant of the Academician M.S. Vovsi of Department of Therapy and Polymorbid Pathology
2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993
A. I. Kochetkov
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Alexey I. Kochetkov, Cand. Sci. (Med.), Associate Professor of the Department of Therapy and Polymorbid Pathology named after Academician M.S. Vovsi
2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993
A. A. Tyazhelnikov
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Andrey A. Tyazhelnikov, Dr. Sci. (Med.), Professor, Professor of the Department of Public Health and Healthcare named after Yu.P. Lisitsyn
1, Ostrovityanov St., Moscow, 117997
E. V. Mironova
Central Clinical Hospital “RZD-Medicine”
Russian Federation
Russian Federation
Elena V. Mironova, Cand. Sci. (Med.), Head of the Cardiology Department, Cardiologist
2, Budayskaya St., Moscow, 129128
N. M. Doldo
Central Clinical Hospital “RZD-Medicine”
Russian Federation
Russian Federation
Nicolai M. Doldo, Head of the Therapeutic Department, Cardiologist,
2, Budayskaya St., Moscow, 129128
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For citations:
Ostroumova OD, Telkova SS, Kochetkov AI, Tyazhelnikov AA, Mironova EV, Doldo NM. Integrated management of a polymorbid patient with hypertension and coronary artery disease: A case report and literature review. Meditsinskiy sovet = Medical Council. 2026;(7):228-236. (In Russ.) https://doi.org/10.21518/ms2026-166
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