PP.21.03

Abstract

Objective: To evaluate the influence of fixed combination of perindopril and amlodipine on conductive and collagen-forming function of arterial wall in patients with arterial hypertension and COPD. Design and method: 60 patients with AH and CAD complicated with CHF, and accompanied with COPD were randomized into 2 equal groups for different antihypertensive treatment. Patients in the 1st group received fixed combination of perindopril and amlodipine (the dose titrated depending on baseline blood pressure). Patients in the 2nd group received enalapril or non-fixed combination of enelapril and amlodipine. Duration of therapy consisted of 6 months. Average age was 55,28 ± 7,81 years. Average AH grade was 2,32 ± 0,87. To evaluate vascular remodelling volume sphygmography was performed with VaSera VS-1000 device (Fucuda, Japan) determining right and left branch-ankle pulse wave velocity (R-PWV, L-PWV), cardio-ankle vascular index (CAVI1), carotid-femoral pulse wave velocity (PWV), PWV in aorta (aPWV) and carotid (cPWV), R-AI and C-AI augmentation indices. Type-1 tissue inhibitor of matrix metalloproteinases (TIMP-1), a common marker of arterial collagen matrix status was evaluated. Results: There was no worsening of COPD course during treatment. Also, there were no significant differences between the groups in goal BP achievement. In 2nd group BP < 110/70 mm Hg registered more often than in 1st one (p = 0.036). During therapy, both R-PWV and L-PWV in 1st group decreased significantly more, than in 2nd: 11,3 ± 3,4 and 16,6 ± 7,2% vs 2,7 ± 0,3 and 1,8 ± 0,5% (p < 0,001 and p < 0,001 respectively). CAVI1 in 1st group decreased more, than in 2nd: 1,8 ± 0,5% and 0,8 ± 0,2% (p = 0,003). PWV in aorta and C-PWV in 1st group decreased significantly more, than in 2nd: (p < 0,001 and p < 0,001 respectively). PWVcf decreased in 1st group on 19,5 ± 1,8, in 2nd one on 11,8 ± 2,19%, (p = 0,005). R-AI significantly decreased in 1st group, than in 2nd: 1,6 ± 0,5% vs 0,4 ± 0,1% (p < 0,001). TIMP1 significantly decreased in 1st group, than in 2nd (p < 0,001). Conclusions: Fixed combination of perindopril and amlodipine in AH and COPD patients provides more evident vasoprotective effect than non-fixed combinations of enalapril and amlodipine because of its physiological evaluation on diurnal BP profile without hypothensia. Both perindopril and amlodipine do not worse COPD course.