Gender differences in the effects of renin-angiotensin system inhibitors and calcium channel blockers in combination therapy with diuretics on indicators of arterial hemodynamics, vascular stiffness and structural and functional state of the heart
Journal Title: Український терапевтичний журнал - Year 2019, Vol 0, Issue 2
Abstract
Objective — to compare the gender-associated effects of 6-month (М6) treatment of patients aged < 65 years with arterial hypertension (AH) 1—2 degree using angiotensin-converting enzyme inhibitor (ACE inhibitor) or angiotensin II receptor blocker (ARB) compared with calcium channel blocker (CCB), if necessary — in combination with thiazide diuretic (indapamide) on the parameters of brachial and central blood pressure (BP), arterial stiffness and structural and functional state of the heart. Materials and methods. The study involved 157 patients (84 men and 73 women) aged 35 to 65 years (mean age (53.8 ± 0.64) years) with uncomplicated AH of І—ІІ stage, 1—2 degrees. Patients were randomized by the blind envelopes into 2 groups depending on the administered therapy: in group A patients received ACE inhibitor (perindopril 5—10 mg) or ARB (olmesartan 20—40 mg); in group B they were administered CCB (lercanidipine 5—10 mg). If the target office brachial BP (bBP) (< 140/90 mm Hg) was not reached, the dose of each antihypertensive drugs (AHD) was increased to a full therapeutic level, and on the next step, if needed, indapamide was added in a dose of 25 mg 1 pd. All patients underwent general clinical examinations, brachial blood pressure measurements, a pulse wave analysis and a measurement of the carotid-femoral and carotid-radial pulse wave velocity (PWVfem., PWVrad.) by applanation tonometry, dopplerechocardiography, and calculation method determined the effective arterial (Ea), ventricular elastance (Ees), ventricular-vascular coupling parameter (Ea/Ees). Results and discussion. The study was completed by 137 patients (78 men and 59 women), 71 were from group A (41 men and 30 women), 66 from group B, including 37 men and 29 women. After 6 months of treatment, the following significant results were achieved in all patients: decreased brachial systolic (bSBP), diastolic (bDBP), mean (mBBP) pressure, which were accompanied by a decrease in central systolic (cSBP), diastolic (cDBP), pulse (cPBP), mean (mCBP) pressures, total peripheral vascular resistance (TPVR) (р < 0.01, р < 0.001). Regardless of the type of treatment, the achieved levels of bSBP, bDBP and mBBP were lower in women than in men (p < 0.05; p < 0.01), whereas lower levels of central blood pressure for the period M6 were determined in women, comparatively with men only with CCB-based treatment. The treatment with ACE inhibitors/ARB did not affect the values of pressure (AP) and augmentation index (AIx) in both men and women (p < 0.05). At the same time, CCB-based therapy contributed to the AP decrease in patients of both genders, and the augmentation index normalized at heart rate 75 (AIх75) — only in women (p < 0.01) while maintaining gender differences in M6. PWV rad. and PWV fem. did not differ from the beginning of the study, and after 6 months they decreased equally regardless of treatment and gender (p < 0.05 and p < 0.01). AHD, regardless of the type, did not significantly affect to the structural parameters (wall thickness, left ventricular mass index (LVMI), ejection fraction, LV diastolic function in men and women (p > 0.05), except for a decrease in LVMI in men compared to 9.5 % for CCB (p < 0.05). In all groups after treatment Ea and Ееs were decreased (all p < 0.01, p < 0.001), but the rate of ventricular-vascular coupling parameter Еа/Ees did not change (all p > 0.05). Conclusions. Treatment of patients with 1—2 degrees of AH during 6 months with ACE inhibitors/ARB ± indapamide or CCB ± indapamide, both men and women, resulted in the significant decrease in brachial and central blood pressure. However, regardless of the type of treatment, women achieved lower levels of brachial blood pressure than men. CCB-based therapy, compared to ACE inhibitors/ARB therapy, contributed to more pronounced decreased in central blood pressure in women, decreased the AP both men and women, AIx75 in women. In addition, 6-months antihypertensive therapy using CCB ± indapamide was reduce LVMI on 9.3 %, but only in men, which was not accompanied by changes in diastolic function, regardless of the type of treatment and gender.
Authors and Affiliations
K. P. Lazarieva
Keywords
Related Articles
- EP ID EP624215
- DOI 10.30978/UTJ2019-2-40
- Views 89
- Downloads 0
Diseases of civilization: liver and polymorphic metabolic continuum
The paper presents considerations of the role of liver in the lipoproteins’ exchange and possibilities of correlation of its disturbances within metabolic syndrome as the most typical manifestation of polymorbid patholog...
Personalized approaches to the primary prevention of cardiovascular diseases
Objective — to evaluate the anthropometric indices, the level of blood lipids, as well as their dynamics in the course of modifying of lifestyle in individuals with different variants of polymorphic loci of beta-adrener...
Metabolic disorders in patients with arterial hypertension with concomitant obesity
Objective — further investigation of the pathogenetic triggers of arterial hypertension with concomitant obesity. Materials and methods. Examinations involved 111 patients with arterial hypertension (AH) with concomitant...
The effectiveness of differentiated therapy with renin-angiotensin-aldosterone blockers in patients with heart failure and type 2 diabetes mellitus
Objective — to evaluate the efficacy of differentiated therapy for ACE inhibitors and ARB II in patients with HFpEF and type 2 diabetes mellitus (DM 2), depending on the M235T polymorphism of the ATG gene. Materials and...
The peculiarities of heart remodeling in patients after myocardial infarction with ST-segment elevation depending on the Lys198Asn polymorphism of endothelin 1 gene
Objective — to investigate clinical and genetic aspects of associations of Lys198Asn endothelin 1 (EDN 1) gene polymorphism with the development of remodeling after myocardial infarction with ST-segment elevation (STEMI)...