PP.12.25] TREATMENT WITH AZILSARTAN MEDOXOMIL IMPROVED DIPPING STATUS IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Abstract

Objective: Type 2 diabetes mellitus (T2DM) is characterized by high prevalence of uncontrolled arterial hypertension (AH) and non-dipping status – important determinant of cardiovascular mortality and morbidity. Azilsartan medoxomil (AZM) is a powerful angiotension receptor blocker (ARB) that can improve 24-h BP profile in this patient population. The aim of the study was to evaluate changes in office and 24-hour BP in patients with AH and T2DM receiving ineffective free dual antihypertensive combination after replacement of renin-angiotensin-aldosterone inhibitor (iRAAS) by AZM. Design and method: 30 patients with AH and T2DM with uncontrolled blood pressure >140/85 mmHg on dual AHT were included (53% females, mean age 60.4 ± 7.6 years (M ± SD), 40% smokers). 63% received ACE inhibitors, 37% - other ARB. The other drug was thiazide diuretic in 57%, CCB in 30% and BB in 13%. iRAAS was replaced by 40 mg of AZM with up-titration to 80 mg after 6 weeks in the case of uncontrolled AH. Study duration was 12 weeks. BP was measured with a validated oscillometric device (OMRON 705CP-II). Arterial stiffness was measured by applanation tonometry (SphygmoCor, AtCor). 24-h peripheral and central BP monitoring was performed (BPLab Vasotens, «Petr Telegin»). P < 0.05 was significant. Results: After 12 weeks target BP was achieved in 25 (83%) patients. Up titration of AZM was performed in 11 (37%) patients. Office BP significantly decreased from 160 ± 16/89 ± 9 mmHg to 125 ± 7/73 ± 6 mmHg, p < 0.05. Baseline and achieved 24-h peripheral BP levels were as follows: 147 ± 17/84 ± 10 and 125 ± 9/75 ± 6 mmHg for daytime, 138 ± 22/76 ± 11 and 114 ± 8/67 ± 6 mmHg for nighttime and 144 ± 19/82 ± 10 and 120 ± 8/71 ± 6 mmHg for 24-h, p < 0.05 for trend. Normalization of daytime BP was observed in 27 (90%) patients, nighttime BP in 22 (73%), 24-h BP in 28 (93%) patients. The baseline dipping states were as follows: 27% dippers, 53% non-dippers, 20% reverse dippers, 0% extreme dippers. Treatment with AZM resulted in 13% increase in dippers and absence of reverse dippers (p = 0.02). Conclusions: Replacement of iRAAS by AZM results in target BP achievement in 83% of patients and normalization of 24-h BP and improvement of dipping state in the majority of patients with T2DM and uncontrolled AH.