Nedogoda S V, Chumachek E V, Ledyaeva A A, Tsoma V V, Salasyuk A S, Smirnova V O, Hripaeva V Ju, Palashkin R V
Volgograd State Medical University, Volgograd, Russia.
Kardiologiia. 2017 Feb;57(2):5-11.
to assess the potential of fixed perindopril/indapamide combination (FPIC) to improve angioprotection in patients with arterial hypertension (AP) with various efficacy of preceding therapy with combination of losartan and hydrochlorothiazide (HCTZ).
We included in this open study 50 patients with AP divided into two equal-sized groups in dependence on the achievement of target blood pressure (BP) less than 140/90 mm Hg on preceding therapy with losartan (100 mg) and HCTZ (12.5 mg). All patients underwent ambulatory BP monitoring (ABPM), applanation tonometry (assessment of augmentation index and central blood pressure), measurement of pulse wave velocity (PWV), laboratory tests (lipid profile, fasting glucose, HOMA index, homocysteine, leptin, adiponectin, high sensitivity C reactive protein [hsCRP]). Study duration was 12 weeks.
Treatment with FPIC in patients not at target BP provided 14.5 and 6.6% reduction of systolic and diastolic BP (SBP and DBP), respectively (p<0.01), while in patients with target BP it was associated with additional reductions of SBP and DBP by 3.9 and 5.4%, respectively (p<0.01). According to ABPM data average day- and nighttime SBP decreased by 16.9 and 15.0%, average day- and nighttime DBP - by 10.6 and 13.6% (p<0.01) in the group of patients not at target BP. Reductions of PWV (by 15.2 and 2.2%), augmentation index (by 10.7 and 9.4%), central SBP (by 10.9 and 2.1%), central pulse BP vascular age (by 8.7 and 6.0%) were observed in groups of patients without and with target BP on preceding therapy, respectively (p<0.01). Leptin level decreased by 10.0 and 14.4%, hsCRP - by 17.7 and 11.0%; while level of adiponectin increased by 6.7 and 9.9% (p<0.01).
Our results demonstrated advantages of FPIC over losartan+HCTZ combination relative to BP control, improvement of arterial elasticity, alleviation of insulin resistance and inflammation.
评估固定剂量培哚普利/吲达帕胺复方制剂（FPIC）在不同疗效的氯沙坦与氢氯噻嗪（HCTZ）联合前期治疗的动脉高血压（AP）患者中改善血管保护作用的潜力。
在这项开放性研究中，我们纳入了50例AP患者，根据前期使用氯沙坦（100mg）和HCTZ（12.5mg）治疗时是否达到目标血压（BP）低于140/90mmHg，将其分为两个等规模的组。所有患者均接受动态血压监测（ABPM）、压平眼压测量（评估增强指数和中心血压）、脉搏波速度（PWV）测量、实验室检查（血脂谱、空腹血糖、HOMA指数、同型半胱氨酸、瘦素、脂联素、高敏C反应蛋白[hsCRP]）。研究持续时间为12周。
未达到目标BP的患者使用FPIC治疗后，收缩压和舒张压（SBP和DBP）分别降低了14.5%和6.6%（p<0.01），而达到目标BP的患者SBP和DBP又分别额外降低了3.9%和5.4%（p<0.01）。根据ABPM数据，未达到目标BP的患者组白天和夜间平均SBP分别降低了16.9%和15.0%，白天和夜间平均DBP分别降低了10.6%和13.6%（p<0.01）。在前期治疗未达到目标BP和已达到目标BP的患者组中，分别观察到PWV降低（15.2%和2.2%）、增强指数降低（10.7%和9.4%）、中心SBP降低（10.9%和2.1%）、中心脉压血管年龄降低（8.7%和6.0%）（p<0.01）。瘦素水平降低了10.0%和14.4%，hsCRP降低了17.7%和11.0%；而脂联素水平升高了6.7%和9.9%（p<0.01）。
我们的结果表明，相对于氯沙坦+HCTZ联合制剂，FPIC在控制血压、改善动脉弹性、减轻胰岛素抵抗和炎症方面具有优势。
