Hemodynamic reaction to orthostasis in hypertensive men with chronic venous diseases taking a combination of an angiotensin-converting enzyme inhibitor and diuretic

Objective. To assess the hemodynamic reaction to orthostasis in hypertensive men with chronic venous diseases (CVenD) taking a combination of an angiotensin-converting enzyme inhibitor (ACE inhibitor) and a diuretic.
Design and methods. We enrolled 44 men aged 30–50 years old with uncontrolled hypertension (HTN) who were taking antihypertensive therapy (AHT). We performed a comparative assessment of the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, femoral peripheral venous pressure (PVP), diameter and area of the lumen, blood flow velocity in the superficial and deep veins of the left lower limb in response to orthostasis. The patients were divided into two groups: 22 patients with HTN without chronic venous insufficiency, 22 patients with HTN and chronic venous disease. We studied the reaction at 3 minutes of orthostasis before and after 14 days of AHT in a hospital using ACE inhibitors (Perindopril) and a diuretic (Indapamide).
Results. Before treatment, the reaction to orthostasis was similar in both groups, we registered a decrease in SBP, PVP, blood flow velocity and an increase in diameter, lumen area of all veins. As a result of treatment, 40 patients reached a level of SBP < 140 mm Hg. Of these, there were 19 patients without CVenD, and 21 patients with CVenD. After treatment, the reaction to orthostasis was similar for the most of the studied parameters. However, there were some differences between the groups. After treatment, patients with HTN and CVenD demonstrated a decrease in SBP, the absence in DBP change, a 4-fold drop in PVP, and orthostatic hypotension was registered in 3 cases. After treatment, in patients with CVenD with orthostasis, SBP and DBP were significantly lower than in patients without CVenD (p = 0,0014 and p = 0,0028, respectively). The difference in SBP between groups after treatment was 12 mm Hg (9%), according to DBP — 6 mm Hg (7%).
Conclusions. At baseline and after a 14–15-day use of the combination of ACE inhibitors and a diuretic, the reaction to orthostasis was similar for most of the studied parameters. In patients with HTN and CVenD, the main features of the reaction to orthostasis included a decrease in SBP, the absence of DBP change, a 4-fold drop in PVP, and orthostatic hypotension registered in 3 cases.

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