Antihypertensive and target-organ protective effects of fixed-dose combinations of amlodipine/lisinopril and bisoprolol/hydrochlorothiazide

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Abstract

Aim - to compare the effect of the fixed-dose combination (FDC) amlodipine/lisinopril (A/L) and bisoprolol/hydrochlorothiazide (B/H) on blood pressure (BP) and stiffness parameters of common carotid arteries (CCA). Methods. The study involved 60 patients with hypertension stage II, grade 1-2 (31 men, 29 women, mean age 53.6±0.8 years). All participants were randomized into two groups of 30 individuals each. Patients of the first group (16 men, mean age 52.7±1.1 years) received FDC A/L in the start dose of 5/10 mg, the second group patients (15 men, mean age of 54.6±1.0 years) - received FDC B/H in the start dose of 2.5/6.25 mg. Medications’ doses were titrated every 14 days to achieve a target BP below 140/90 mm Hg and after that the subsequent therapy in selected dose combination for 12 weeks was continued. At baseline and at the end of follow-up period ambulatory BP monitoring and triplex ultrasonic examination of the CCA were performed. Results. All 60 patients had the target values of office BP. During antihypertensive therapy significant (p<0.05) reduction in office systolic BP - SBP (-23.8±2.5 and -16.6±2.4 mm Hg, respectively), diastolic BP - DBP (-13.5±1.3 and -11.2±1.0 mmHg, respectively), pulse pressure - PP (-10.4±2.0 and -5.4±1.9 mm Hg, respectively) was revealed in groups A/L and B/H. In the A/L group compared with the B/H group it was significantly (p<0.05) greater reduction in SBP and PP. In the A/L and B/H groups a significant (p<0.001) reduction in the daytime SBP (-19.0±1.8 and -17.1±1.6 mm Hg, respectively), daytime DBP (-12.5±1.2 and -11.2±1.2 mm Hg, respectively), daytime PP (-6.5±1.2 and -6.0±1.0 mm Hg, respectively), as well as nighttime SBP (-19.9±1.8 and -18.3±2.0 mm Hg, respectively) and nighttime DBP (-14.4±1.9 and -17.3±1.9 mm Hg, respectively) was observed. As opposed to the B/H, the A/L was showed a significant (p<0.001) reduction in the nighttime PP (-5.1±1.2 mm Hg). At the end of the follow-upmore patients in A/L group had target values of nighttime SBP than in the B/H group (80% and 43.3%, respectively, p<0.01). Daytime SBP variability was significantly (p<0.05) decreased in both groups, and in the A/L group it was significantly (p<0.05) greater compared with B/H (-2.7±0.7 and -0.9±0.3 mm Hg, respectively). Also therapy with A/L, in contrast with B/H, have shown a significant (p<0.05) decrease in nighttime SBP variability (-1.2±0.5 mm Hg) and day - and nighttime DBP variability (-0.7±0.3 and -1.4±0.6 mm Hg, respectively). After 12 weeks of A/L treatment a significant (p<0.01) decrease in the value of the CCA stiffness index (-15.2±3.8%) and the Young's modulus (-25.5±6.0%) of the CCA and in the Peterson’s elastic modulus of the CCA (-19.2±6.0%) have been noticed, and there was a significant increase in the CCA cross-sectional compliance (30.3±7.5%) and the CCA distensibility coefficient (52.9±9.3%). There were no significant changes in the CCA stiffness parameters in the B/H group. Conclusion. In untreated patients with arterial hypertension aged 45 to 65 years 12-week therapy FDC A/L has greater antihypertensive efficacy compared with FDC B/H. FDC A/L, but not FDC B/H improved elastic properties of the CCA.

About the authors

O. D Ostroumova

A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation; I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

Email: ostroumova.olga@mail.ru
д-р мед. наук, проф. каф. факультетской терапии и профболезней ФГБОУ ВО МГМСУ им. А.И.Евдокимова; проф. каф. клинической фармакологии и пропедевтики внутренних болезней ФГБОУ ВО Первый МГМУ им. И.М.Сеченова 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1; 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2

A. I Kochetkov

A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation

Email: ak_info@list.ru
ассистент каф. факультетской терапии и профболезней ФГБОУ ВО МГМСУ им. А.И.Евдокимова 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1

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