Organ-protective effect of fixed-dose combination antihypertensive therapy with eprosartan and hydrochlorothiazide for subclinical and clinical target organ damage in hypertensive patients

Abstract

Aim: to evaluate the efficiency of starting fixed-dose combination therapy with eprosartan and hydrochlorothiazide on the clinical and subclinical parameters of target organ damage in patients with hypertensive disease (HD) irrespective of baseline blood pressure (BP) and cardiovascular risk. Subjects and methods. The study consisted of two parallel substudies. Substudy 1 that screened 3536 workers from industrial enterprises identified 395 (13%) hypertensive patients. Among them, there were 50 (12,7%) untreated patients with HD who had three-component target organ damages: left ventricular hypertrophy, hypertensive nephropathy, peripheral artery lesion. Sixty (15,2%) untreated patients with Stage 1 HD without clinical signs of organ changes were recorded among the same cohort in Substudy 2. In both substudies, Group 1 received a fixed-dose combination of eprosartan mesylate 600 mg once daily and hydrochlorothiazide 12,5 once daily regardless of baseline BP at the onset of the study. Group 2 had monotherapy with enalapril and/or its combination with hydrochlorothiazide depending on the degree of BP elevation and the group of a cardiovascular risk. Results. Starting fixed-dose combination antihypertensive therapy (eprosartan + hydrochlorothiazide) irrespective of baseline BP and cardiovascular risk versus monotherapy with enalapril and/or its free combination with hydrochlorothiazide, which was used in terms of BP level and cardiovascular risk ensured a more significant regression of both clinical and subclinical target organ damages during 6-month therapy according to the changes in left ventricular mass (LVM), LVM index, and tissue inhibitor of type 1 matrix metalloproteinases, microalbuminuria and glomerular filtration rate, intima-media complex thickness during carotid Doppler ultrasound study, and pulse wave velocity in different segments, as evidenced by volumetric sphygmoplethysmography. Conclusions. The use of a fixed-dose combination of eprosartan and hydrochlorothiazide in untreated patients of able-bodied age regardless of baseline BP and cardiovascular risk ensures the regression of target organ damages and the prevention of their development in the absence of organ changes.