Evaluating the Impact of Mono- and Combination Antihypertensive Therapy with Dihydropyridine and Non-dihydropiridine Calcium Channel Blockers on the Viscoelastic Properties of Arteries and Central Blood Pressure in Patients with Mild to Moderate Hypertens

Abstract

Introduction. Nowadays, the search for new methods to reduce cardiovascular risk in the population is widely discussed. Many randomized studies have proven the value of the arterial wall stiffness in worsening prognosis for cardiac patients. Therefore, based on these considerations, therapy that improves the elasticity of the arteries maybe have greater efficacy in preventing major cardiovascular events. Objective of this study — to compare the effectiveness of lerkanidipin and diltiazem combination in different doses among patients with mild to moderate hypertension based on the effect on central blood pressure (CBP) and viscoelastic properties of arteries. Materials and methods. The study involved 123 patients with mild to moderate hypertension, the average office systolic (SBP)/diastolic blood pressure (DBP) — 149.12/91.92 ± ± 1.42/0.93 mmHg. Average age of patients was 51.83 ± 0.86 years. All patients were divided into the groups of therapy. The first group of patients (n = 20) received diltiazem at a dose of 240 mg daily in two steps. The second one (n = 20) — lerkanidipin 20 mg once daily. The third one (n = 22) — non-fixed combination of lerkanidipin 20 mg and diltiazem 240 mg a day. The fourth one (n = 20) — non-fixed combination of lerkanidipin 10 mg and diltiazem240 mg daily. The fifth one (n = 21) — non-fixed combination of lerkanidipin 10 mg and diltiazem 120 mg a day. The sixth one (n = 20) — non-fixed combination of lerkanidipin 20 mg and diltiazem120 mg daily. All patients at the beginning and at end of treatment underwent the following studies: measurement of body weight and height, calculation of body mass index. The diagnosis of overweight or obesity was made according to the World Health Organization criteria (1997). Measurements of office SBP, DBP and heart rate (HR), ambulatory BP monitoring, determination of pulse wave velocity in elastic and muscle arteries, central SBP, biochemical blood assay which included determination of total cholesterol, triglycerides, high-, low- and very low-density lipoprotein cholesterol, atherogenic index were carried out. Duration of treatment was 1 month. Results. After analyzing all the data, it was found that parameters of office SBP and DBP decreased significantly in patients with both mild and moderate hypertension in all groups almost equally. CBP in all treatment groups decreased effectively and equally. In the group of 240 mg diltiazem, CBP significantly decreased by 10.95 mmHg, in group of lercanidipin 20 mg — by 12.18 mmHg, in the group of lercanidipin 20 mg and diltiazem 240 mg combination — by 14.13 mmHg, in the group of combination of lercanidipin 10 mg and diltiazem 240 mg — by 11.93 mmHg, in the group of lercanidipin 10 mg and diltiazem 120 mg combination — by 13.11 mmHg, in the group of combination of lercanidipin 20 mg and diltiazem 120 mg — by 14.82 mmHg. That is, all selected treatment regimens were equally effective in reducing CBP. There was no negative impact of all treatments on the level of blood lipids. Central SBP is associated with DBP level during daily monitoring and with the indicators of the viscoelastic properties of arteries, the level of cholesterol, intima-media thickness of the carotid arteries. In different treatment groups we observed various factors that significantly correlated with the end CBP and the degree of its decline. In the combination therapy group, final CBP was associated with the level of end office SBP, office DBP, indicators of the viscoelastic properties of arteries. In the group of monotherapy, final central SBP was significantly inversely associated with the degree of reduction during the treatment of office HR and office SBP level at the end of treatment. The degree of СBP reduction in combination therapy group was significantly associated with indicators of viscoelastic properties of arteries, as well as with intima-media thickness of the carotid arteries and the level of total cholesterol. All treatment regimens did not significantly affect the average values of indicators of the viscoelastic properties of the arteries (due to short-term observation). Conclusion. Monotherapy and combination of lercanidipin and diltiazem were effective in reducing both office BP and BP with daily monitoring and CBP. In connection with the best tolerability of lercanidipin 20 mg daily and low-dose combination of lercanidipin10 mg and diltiazem 120 mg, these treatment strategies can be recommended for future treatment of patients with mild to moderate arterial hypertension.