Integrated management of a polymorbid patient with hypertension and coronary artery disease: A case report and literature review
Year: 2026
Type: article
Study design: Case Report
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.
DOI: 10.21518/ms2026-166
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7202078519