Abstract
BackgroundEssential hypertension has been extensively reported to cause endothelial dysfunction. The aim of this study was to evaluate the effects of barnidipine or lercanidipine, in addition to losartan, on some parameters indicative of endothelial damage and oxidative stress in hypertensive, type 2 diabetic patients.MethodsOne hundred and fifty one patients were randomised to barnidipine, 20 mg/day, or lercanidipine, 20 mg/day, both in addition to losartan, 100 mg/day, for 6 months. We assessed BP every month, in addition, patients underwent ambulatory blood pressure monitoring (ABPM). We also assessed: fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), some markers such as high-sensitivity C-reactive protein (Hs-CRP), tumor necrosis factor-α (TNF-α), metalloproteinase-2 (MMP-2) and -9 (MMP-9), soluble vascular adhesion protein-1 (sVCAM-1), soluble intercellular adhesion protein-1 (sICAM-1), isoprostanes and paraoxonase-1 (PON-1).ResultsBoth barnidipine and lercanidipine resulted in a significant reduction in blood pressure, even if the reduction obtained with barnidipine + losartan was greater than that obtained with lercanidipine + losartan. Data recorded with ABPM also showed a similar trend. Barnidipine + losartan reduced the levels of Hs-CRP, TNF-α, sVCAM-1, sICAM-1, and isoprostanes both compared to baseline and to lercanidipine + losartan.ConclusionsBarnidipine + losartan gave an improvement of some parameters indicative of endothelial damage and oxidative stress in diabetic and hypertensive patients.Trial registrationNCT02064218, ClinicalTrials.gov
Highlights
Essential hypertension has been extensively reported to cause endothelial dysfunction
According to latest European Cardiology Society guidelines, combination of antihypertensive therapy provides greater blood pressure lowering effects than single-agent therapy, and the added benefit of an angiotensin receptor blocker (ARB) and dihydropyridine calcium channel blocker (CCB) combination is a minor incidence of adverse events [11]
We evaluated some markers of oxidative stress such as isoprostanes and paraoxonase-1 (PON-1)
Summary
Essential hypertension has been extensively reported to cause endothelial dysfunction. The aim of this study was to evaluate the effects of barnidipine or lercanidipine, in addition to losartan, on some parameters indicative of endothelial damage and oxidative stress in hypertensive, type 2 diabetic patients. Essential hypertension has been extensively reported to cause endothelial dysfunction, characterised by unbalanced vasodilation and vasoconstriction, increased oxidative stress, vascular inflammation, alteration of prothrombotic and fibrinolytic pathways, abnormal smooth muscle cell. Angiotensin receptor blocker and CCB combination proved to have some pleiotropic effects such as improvement of insulin sensitivity [12], and prevention of new episodes of atrial fibrillation in hypertensive diabetic patients [13]. The pharmacological effects of barnidipine are longer lasting than those of other CCBs such as nifedipine; sustained occupancy of dihydropyridine receptors by barnidipine was observed in vitro as well as in vivo [14]
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