NCREASED CEREBRAL BLOOD FLOW IN MIDDLE-AGED TREATMENT NAIVE HYPERTENSIVE PATIENTS RECEIVING FIXED COMBINATION TREATMENT WITH PERINDOPRIL ARGININE/INDAPAMIDE

Abstract

Objective: To investigate the effect of perindopril arginine/indapamide fixed-dose combination (FC Pa/I) on cerebral blood flow (CBF) in treatment-naive middle-aged patients with uncomplicated grade 1–2 essential arterial hypertension (EAH). Design and method: 22 treatment-naive patients with EAH (mean age 47,6 ± 6,9 years, 10 men, mean blood pressure (BP) 146.2 ± 4.6/93.1 ± 4.3 mm Hg) and 41 healthy normotensive controls (mean age 46,2 ± 4,6 years, 26 men) were recruited. At the baseline all subjects underwent brain MRI (MAGNETOM Skyra 3.0T, Siemens AG, Germany). Arterial spin labeling (ASL) CBF maps were used to calculate the perfusion defects in the cortical plate of both frontal lobes. Patients with EAH received perindopril arginine 5 mg /indapamide 1.25 FC once daily in the morning; if necessary, after 2 weeks (if office blood pressure was 140/90 mm Hg or higher) the dosage was increased up to perindopril 10 mg/ indapamide 2.5. The follow-up period was 14–16 weeks. 22 patients with EAH underwent an additional MRI at the end of follow-up. Results: At the baseline patients with EAH had significantly (p < 0,001) lower CBF in cortical plate of both left (36,2 ± 8,3 vs. 45,3 ± 3,5 ml/100 g/ min) and right (37,9 ± 7,9 vs. 45,8 ± 3,2 ml/100 g/ min) frontal lobes, compared to normotensive controls. At the end of follow-up we found a significant (p < 0,001) increase in CBF in cortical plate of both left (36,2 ± 8,3 vs. 47,5 ± 9,8 ml/100 g/ min) and right (37,9 ± 7,9 vs. 47,4 ± 10,05 ml/100 g/ min) frontal lobes, compared to baseline. Furthermore, no significant difference was found between CBF level at the end of follow-up period in both frontal lobes of patients with EAH, compared to CBF level of healthy controls at baseline. Conclusions: Treatment with FC Pa/I may additionally increase CBF, measured by ASL, in cortical plate of frontal lobes to the normotensive controls’ level in treatment-naïve middle-aged patients with the earliest stages of EAH, which is essential in prevention of hypertension-mediated brain damage.