Possibilities of perindopril and ivabradin in patients with hypertensive disease in the normalization of hemodynamics, myocardial dysfunction and vascular endothelium

Topicality. Evaluation of diastolic characteristics of the left ventricle (LV) in patients with hypertensive heart is important due to the fact that they are formed at a time of increasing myocardial mass of LV, able to progress, manifesting the clinical syndrome of chronic heart failure mainly in old age. Aim is to determine the efficacy of perindopril and ivabradine in the correction of blood pressure and contraction heart rate, as well as the functional parameters of LV myocardial function, vasoregulating function of the endothelium of peripheral arteries in patients with hypertensive disease. Object and methods. The study included 43 men aged 52-64 years with diagnosis of "hypertensive disease" without systematic application of antihypertensive drugs in the past, who had no clinical signs of chronic heart failure, had sinus rhythm more than 75 per minute at rest. The control group included 21 men, comparable in age, without deviation in electrocardiogram and physical signs of heart disease. Echocardiography was performed in all patients included in the study with the help of which the main parameters at rest were defined. We also used Pulse-wave Doppler LV inflow and tissue Doppler mode where we evaluated the movement of the lateral part of the mitral valve ring and phase index of LV. Endurance cycle test was conducted for 2 minutes at 25, 50 and 75 Watts. The function of the endothelium and arterial stiffness were examined by the method of computer based finger-photoplethysmography. The study was divided into 3 visits: on the first visit patients were appointed perindopril (Prestarium® A, Servier) in a dose of 10 mg/day; on the second visit ivabradine (Coraxan®, Servier) in a dose of 7.5 mg twice a day was added for a month; and the third visit was the final stage of the study. Results. The systolic and diastolic pressure during lying down position, sitting position and under load of 25 watts during the last visit of the group of patients with hypertensive disease did not differ from the control group, according to the results of blood pressure measurement. Ivabradine in addition to perindopril significantly increased the bradycardia effect and the results in investigated group of patients and in the control one were practically the same taking into account heart rate in a wide range of physiological states. Peripheral vascular endothelial function indicator during the observation completely normalized. In the study of phase index of LV we showed that physical activity and changing body position could significantly influence towards the increase, both in healthy people and in patients with hypertensive heart. Conclusion. We demonstrated significant hypotensive effect of perindopril at rest, and at dynamic load and the efficacy of ivabradine in heart rate normalization. We showed the high sensitivity of phase index of LV as a marker of left ventricular dysfunction, the dynamic changes of the index in response to normalizing the blood pressure and heart rate, regardless of LV myocardial mass, as well as the ability to normalize vasculomotor function of endothelium of peripheral artery, that provided the basis for improving vascular stiffness parameters later.

diastolic dysfunction, phase myocardial index, chronic heart failure, perindopril, ivabradine