Comparative effects of antihypertensive therapy modes on the wall rigidity of various blood vessels

Objective. The purpose of the study was the comparative analysis of the vasoprotective effects of a fixed combination of perindopril and indapamide (Noliprel A‑Bi-Forte, Servier) and the combination of enalapril and hydrochlorothiazide (Co-Renitec, MSD) on various sites of the arterial bed in hypertensive patients.

Design and methods. Depending on the mode of antihypertensive therapy (AHT) the patients were randomized into 2 groups: patients of the 1st group (41 persons) received a fixed combination of perindopril A (10,0 mg) and indapamide (2,5 mg), and those from the 2nd group (34 persons) received a fixed combination of enalapril maleate (20,0) mg and hydrochlorothiazide (12,5 mg). The aorta and major arteries were assessed with the use of the device VaSera‑1000 («Fukuda Denshi», Japan), and the following parameters were evaluated: velocity of propagation of pulse wave in the aorta, cardio-ankle vascular index and biological age of the arteries. The peripheral arteries were estimated using the device Pulse Trace PCA, and stiffness index, reflection index and vascular age were measured. All assessments were performed at baseline and at 1-, 3‑and 6‑months and at 1‑year follow-up.

Results. Both combinations resulted in a significant decrease of vascular wall stiffness of the aorta and major arteries, but in the 1st group of patients the changes were observed earlier (after 3 to 6 months), and were more expressed. At the same time vasoprotective effects in peripheral arteries were observed only in 1st group of patients who received perindopril and indapamide.

Conclusions. Leading to a significant reduction of the vascular wall rigidity both in aorta, major and peripheral arteries, a combination of perindopril and indapamide provides the most effective vasoprotection.

1. Boytsov SA, Bulanova JA, Shal’nova SA, Deev AD, Artamonova GV, Libis RA et al. Hypertension among persons 25–64 years of age: prevalence, awareness, treatment and control (based on the study ESSE). Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2014;4:4–14.

2. Filippov EV, Yakushin SS. The prevalence of hypertension and characteristics of patients with hypertension and the risk of various cardiovascular complications. Meditsinskij Sovet = Medical Council. 2013;9:65.

3. Smirnova MI, Oganov RG, Gorbunov VM, Deev AD, Andreeva GF. The hidden effectiveness of treatment of hypertension: the frequency and predictors. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2011;6:11–17.

4. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105–1187.

5. Diagnosis and treatment of hypertension. Russian recommendation — the third revision Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2008 App. 2.

6. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Russ J Cardiol. 2014;1(105):7–94.

7. Blacher J, Guerin A, Marchias SJ, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99(18):2434–2439.

8. Orlova YA. The stiffness of the arteries as a predictor of cardiovascular complications in coronary artery disease. Ther Arch. 2010;82(1):68–73.

9. Boytsov SA. Vessels as a base and a target arterial hypertension. In: Boytsov SA. Diseases of the heart and blood vessels. 2006;1(3).

10. IvanenkoVV, Rotar OP, Konradi AO. Correlation of stiffness of the vessel wall with various cardiovascular risk factors. Arterial’naya Gipertenziya = Arterial Hypertension. 2009;15(3):290–295.

11. Lukyanov MM, Boytsov SA. The stiffness of the arterial wall as a factor of cardiovascular risk and prognosis in clinical practice. Lukyanov MM, Boytsov SA. Serdtse: Zhurnal dlya praktiluyuschikh vrachei = Heart: The Journal for Practitioners. 2010;9(3):156–159.

12. Drobotya NV, Guseynova ES, Kaltykova VV, Kirichenko AA, Demidova AA. A mathematical model for predicting the impact of organoprotective antihypertensive therapy with perindopril and indapamide. Bulletin of National Medical and Surgical Center n. a. NI Pirogov. 2013;8(2):62–65.

13. Ferrari AU, Radaelli A, Centola M. Aging and the cardiovascular system. J Appl Physiol. 2005;95(6):2591–2597.

14. Milyagin VA, Milyagina IV, Abramenkova NY, Otrokhova EV, Grekova MV, Kopteva VV et al. Noninvasive study of major vessels: monograph. Smolensk, 2012. 224 p.

15. Drapkina OM, Mandzhieva BA. Vascular age, aging mechanisms of the vascular wall. Methods for determination of vascular age. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2014;5:74–82.

16. Mathiassen ON, Buus NH, Sihm I, Thybo NK, Mørn B, Schroeder AP et al. Small artery structure is an independent predictor of cardiovascular events in essential hypertension. J Hypertens. 2007;25(5):1021–1026.

17. Folkov B, Nil E. Blood circulation. The lane with English. Moscow, 1976.

18. Martynov AI, Sharkov NE, Obukhov AA. Change the elastic properties of the elastic parameters and peripheral vascular endothelial function during treatment with combined drug perindopril plus indapamide in hypertensive patients. Kardiologiia. 2008;48(4):25–28.

19. Logacheva IV, Ivanova IV, Pocheptsova LV. Evaluation of protection properties of blood vessels and organs fixed combination of perindopril/indapamide in patients with arterial hypertension. Arterial’naya Gipertenziya = Arterial Hypertension. 2009;15(3):300–308.