The specificity of the antihypertensive action of the renin-angiotensin system inhibitors

Abstract

Objective: the determination of the presence and character of action of the agents suppressing the renin-angiotensin system activity, their ability not only induce antihypertensive effect but also influence on the atherogenic blood potential and vascular remodeling in patients with arterial hypertension.Material and methods. 97 patients with stage 1 and 2 arterial hypertension were enrolled in the investigation. All patients were divided into 3 groups: 1) persons who were treated with receptor angiotensin II blockers 2) patients who were treated with ACE inhibitors (50 persons) 3) (control, 20 persons) patients who were treated with calcium channel blockers. All patients additionally received hydrochlorothiazide. The duration of the investigation was 1+0,1 year. There were measured the levels of SAP, DAP and pulse pressure. There was also determined the blood content of glucose, cholesterol, triglyceride, cholesterol of high-density lipoproteins with the use of analyzer BioSystems A‑25 (Spain). Level of low and very low density lipoprotein cholesterol was calculated according to the Freedwald formula. The echocardiographic investigation was carried out in M and B regimes according to the standard protocol. The cardiac activity, double product, total peripheral vascular resistance were calculated. The obtained data were analyzed statistically with the application of the program Excel 2003. The changes were considered as significant in р<0,05. Results. The development of arterial hypertension was the result of functional and structural remodeling of the arterial vessels wall with an increase of total vascular resistance on the background of unchanged central hemodynamics in conjunction with the increase of cardiac activity and its demand in blood supply, which meant the decrease of the economy of heart activity. In parallel rose the blood atherogenic potential with increasing of the blood content of low and very low-density lipoprotein cholesterol, decreasing of high-density lipoprotein cholesterol and growth of atherogenic index. Application of calcium channel blockers with diuretics had pronounced antihypertensive effect but nevertheless, SAP pulse pressure and the level of total vascular resistance remained higher in comparison with normal values. That pointed only to the partial elimination of vascular remodelling. There was not also marked the influence on increased atherogenic potential. On the contrary, the application of renin-angiotensin system inhibitors led to the achievement of the target level of AP with a primary decrease of SAP and pulse pressure in conjunction with almost complete normalization of vascular resistance that witnessed about the pronounced regression of vascular remodeling. As a result, there was marked the significant decrease of the heart work and his blood supply demand, which pointed to the optimization of heart activity. There was also marked the significant decrease in blood atherogenic potential. Conclusions. The data proves the significant priority of the antihypertensive therapy with application of renin-angiotensin system inhibitors. That was proved by more pronounced AP normalization, more pronounced regression of the vascular remodelling, significant decrease of blood atherogenic potential and lowering as a result the risk of ischemic heart disease development.