Department of Cardiology, King George Medical University, Shah Mina Road, Chowk, 226003, Lucknow, Uttar Pradesh, India.
Cardiovasc Ther. 2020 Sep 7;2020:4349612. doi: 10.1155/2020/4349612. eCollection 2020.
Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension.
This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens.
A total of 199 patients with a mean age of 54.22 ± 10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure (SBP) < 140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13 ± 12.43 vs. 54.22 ± 10.15, = 0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations ( < 0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments ( = 0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments ( < 0.05). A total of 6.5% patients experienced any side effects.
The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.
与单独使用肱动脉血压测量相比，中心主动脉血压（CABP）指数、中心血液动力学和动脉僵硬度是更好的心血管事件预测指标。本研究旨在评估涉及肾素-血管紧张素-醛固酮系统（RAAS）抑制剂的不同降压药物联合方案对印度高血压患者 CABP 指数的影响。
这是一项横断面、单中心研究，在使用不同治疗方案治疗高血压超过 6 周的患者中进行，这些方案涉及 RAAS 抑制剂与其他类别的药物联合使用。使用非侵入性 Agedio B900 设备（IEM，德国 Stolberg）测量患者的 CABP 指数、血管年龄、动脉僵硬度和中心血液动力学，并比较不同治疗方案之间的差异。
共纳入 199 名平均年龄为 54.22 ± 10.15 岁的患者，其中 68.8%的患者高血压病史超过 3 年，50.25%的患者收缩压（SBP）<140mmHg。血管紧张素 II 受体阻滞剂（ARB）和血管紧张素转换酶抑制剂（ACEI）联合治疗分别给予 77.9%和 20.1%的患者。平均血管年龄高于实际年龄（58.13 ± 12.43 岁比 54.22 ± 10.15 岁， = 0.001）。与 ARB 为基础的联合治疗相比，ACEI 为基础的联合治疗患者的 SBP 和舒张压（DBP）水平较低（ < 0.05）。与其他治疗相比，ACEI 为基础的联合治疗患者的中心脉搏压放大率、增强压和增强指数较低（ = 0.001）。在亚组分析中，与其他治疗相比，给予培哚普利和钙通道阻滞剂（CCB）或利尿剂的患者的 CABP 和脉搏波速度显著较低（ < 0.05）。共有 6.5%的患者出现任何不良反应。
与 ARB 相比，大多数中心血液动力学参数，包括血管年龄，在接受 ACEI 治疗的患者中改善更为明显。我们的结果表明，在印度的常规临床实践和基于证据的指南之间存在差距，并确定需要重新评估当前的降压药物处方策略。
