Антигипертензивная терапия и ригидность артериальной стенки у больных пожилого возраста с неклапанной фибрилляцией предсердий

Stiffness of the arterial wall is an independent predictor of cardiovascular morbidity and mortality from cardiovascular causes. Therefore, search for more effective therapeutic approaches to improve the elasticity properties of the arterial wall are necessary. Objective. Compare the effects of angiotensin-converting enzyme (perindopril), dihydropyridine calcium antagonist (lercanidipine), angiotensin receptor blockers II (valsartan) and its combination with a statin (rosuvastatin) for the elasticity of the arterial wall in elderly patients with nonvalvular atrial fibrillation (AF) and hypertension (AG) on the basis of ultrasound examination.
Design and methods. We examined 189 patients (110 men and 79 women) aged 65 to 80 years with nonvalvular atrial fibrillation and hypertension, which were randomly assigned to four groups. Patients in the first group (n = 47) took perindopril in the dose of 5-10 mg/day, in the second (n = 48) - valsartan at the dose of 80-160 mg/day, in the third (n = 48) - valsartan at the same dose in combination with rosuvastatin 10 mg/day, in the fourth (n = 46) - lercanidipine at the dose of 10-20 mg/day. At baseline, after 1 and 2 years blood pressure levels, elastic properties of the thoracic aorta and carotid arteries by ultrasound and cardiovascular complications were assessed. Results. Treatment increased distensibility index of the common carotid artery, decreased stiffness aortic wall and pulse wave velocity in all four groups compared to baseline. The combination of valsartan with rosuvastatin exerted the most pronounced effect on the vascular wall compliance, reduces the frequency of ischemic stroke, myocardial infarction, and mortality.
Conclusion. Valsartan in combination with rosuvastatin may be regarded as the best strategy to improve the elastic properties of the arterial wall and reduce the incidence of cardiovascular complications in geriatric patients with nonvalvular AF.

antihypertensive therapy, arterial stiffness, atrial fibrillation, ischemic stroke, elderly population

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