Influence of complex drug therapy on structural and functional properties of vessels and endothelial dysfunction in patients with arterial hypertension and ischemic heart disease


DOI: https://dx.doi.org/10.18565/therapy.2021.8.76-83

Umetov M.A., Khakuasheva I.A., Akkaeva M.R., Tamazova M.A., Sanova A.Z., Khakulova D.M.

1) Kabardino-Balkarian State University named after H.M. Berbekov, Nalchik; 2) Cardiological Dispensary of the Ministry of Healthcare of Kabardino-Balkarian Republic, Nalchik
Abstract. Despite significant advances in the treatment of arterial hypertension (AH) and ischemic heart disease (IHD), mortality from these diseases remains high.
Purpose: to compare the effect of bisoprolol and nebivolol in combination with a fixed combination (amlodipine + perindopril + indapamide) on the clinical course, functional state of arterial stiffness, endothelium, ankle-brachial index, vascular age in patients with AH of 2 and 3 degrees and IHD II and III functional classes.
Material and methods. The study included 67 patients with uncontrolled AH with a systolic blood pressure (BP) level of ≥160 mmHg and/or diastolic blood pressure ≥90 mmHg in combination with stable exertional angina, who were taking two antihypertensive drugs at the start of the study. Depending on the therapy, the participants were divided into two groups: I – 34 people who received bisoprolol 5–10 mg/day; II – 33 people who took nebivolol at a dose of 5–10 mg/day. All patients also received a fixed combination of amlodipine + indapamide + perindopril.
Results. The use of a fixed combination of amlodipine, indapamide and perindopril in combination with the beta-blocker nebivolol has a pronounced hypotensive effect on the level of peripheral and central arterial pressure, slows down the processes of vascular remodeling by improving the parameters of arterial stiffness, vascular age, endothelial function indicator, which indicates an improvement in the state of elasticity - the elastic properties of the arterial wall and leads to a decrease in the risk of developing cardiovascular complications.
Conclusion. The results obtained indicate that the addition of nebivolol to the fixed combination amlodipine + indapamide + perindopril leads to an effective decrease in heart rate, improved parameters of arterial stiffness and endothelial function, increased adherence and increased exercise tolerance.
Keywords: vascular age, central aortic pressure, augmentation index, pulse wave velocity, ankle-brachial index, arterial stiffness, endothelial dysfunction
Read entire article

Literature


  1. Virani S.S., Alonso A., Benjamin E.J. et al. Heart disease and stroke statistics – 2020 update: A report from the American Heart Association. Circulation. 2020; 141(9): e139-e596. doi: 10.1161/CIR.0000000000000757.

  2. Клинические рекомендации. Артериальная гипертензия у взрослых. Общероссийская общественная организация «Российское кардиологическое общество» (одобрено Научно-практическим Советом Минздрава России). 2020. Доступ: https://cr.minzdrav.gov.ru/schema/62_2 (дата обращения – 01.10.2021). [Clinical guidelines. Arterial hypertension in adults. Russian Cardiological Society (approved by the Scientific and Practical Council of the Ministry of Healthcare of Russia). 2020. Available at: https://cr.minzdrav.gov.ru/schema/62_2 (date of access – 01.10.2021) (In Russ.)].

  3. Townsend N., Nichols M., Scarborough P., Rayner M. Cardiovascular disease in Europe – epidemiological update 2015. Eur Heart J. 2015; 36(40): 2696–705. doi: 10.1093/eurheartj/ehv428.

  4. Bonow R.O., Mann D.L., Libby P. et al. Braunwald’s heart disease: a textbook of cardiovascular medicine: 10th ed. USA: Elsevier. 2015; pp. 1943.

  5. Ettehad D., Emdin C.A., Kiran A. et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet. 2016; 387(10022): 957–67. doi: 10.1016/S0140-6736(15)01225-8.

  6. Boden W.E., O’Rourke R.A., Teo K.K. et al. COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356(15): 1503–16. doi: 10.1056/NEJMoa070829.

  7. The BARI 2D Study Group, Frye R.L., August P., Brooks M.M. et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009; 360(24): 2503–15. doi: 10.1056/NEJMoa0805796.

  8. Al-Lamee R., Thompson D., Dehbi H.M. et al. Percutaneous coronary intervention in stable angina (ORBITA): A double-blind, randomised controlled trial. Lancet 2018; 391(10115): 31–40. doi: 10.1016/S0140-6736(17)32714-9.

  9. Hochman J.S., Reynolds H.R., Bangalore S. et al.; for the ISCHEMIA Research Group. Baseline characteristics of participants in the ISCHEMIA randomized clinical trial. JAMA Cardiol. 2019; 4(3): 273–86. doi: 10.1001/jamacardio.2019.0014.

  10. Chung C.M., Tseng Y.H., Lin Y.S. et al. Association of brachial-ankle pulse wave velocity with atherosclerosis and presence of coronary artery disease in older patients. Clin Interv Aging. 2015; 10: 1369–75. doi: 10.2147/CIA.S89568.

  11. Sun Z. Aging, arterial stiffness and hypertension. Hypertension. 2015; 65(2): 252–56. doi: 10.1161/HYPERTENSIONAHA.114.03617.

  12. Loboz-Rudnicka M., Jaroch J., Bociaga Z. et al. Relation-ship between vascular age and classic cardiovascular risk factors and arterial stiffness. Cardiol J. 2013; 20(4): 394–401. doi: 10.5603/CJ.2013.0098.

  13. Глезер М.Г. Пульсовое АД: почему это важно? М.: Медиком. 2013; 16 с. [Glezer M.G. Pulse blood pressure: why is it important? Moscow: Medicom. 2013; 16 pp. (In Russ.)].

  14. Steg P.G., Ferrari R., Ford I. et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS One. 2012; 7(5): e36284. doi: 10.1371/journal.pone.0036284. Takeuchi T., Ota N., Hasebe T. [Japan assessment of pitavastatin and atorvastatin in acute coronary syndrome (JAPAN-aCS) study]. Nihon Rinsho. 2011; 69 Suppl 9: 336–40.

  15. Рогоза А.Н. Роль и возможности лодыжечно-плечевого индекса систолического давления в профилактических обследованиях. РМЖ. 2011; 4: 173–179. [Rogoza A.N. The role and possibilities of the ankle-brachial systolic pressure index in preventive examinations. Russkiy meditsisnkiy zhurnal = Russian Medical Journal. 2011; 4: 173–179 (In Russ.)].

  16. Horinaka S., Yabe A., Yagi H. et al. Department of hypertension and cardiorenal medicine, Dokkyo Medical University, Tochigi. Russian Journal of Cardiology. 2011; 2: 111–119 (In Russ.)].

  17. Бойцов С.А., Баланова Ю.А., Шальнова С.А. с соавт. Артериальная гипертония среди лиц 25–64 лет: распространенность, осведомленность, лечение и контроль. По материалам исследования ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2014; 4: 4–14. [Boytsov S.A., Balanova Yu.A., Shalnova S.A. et al. Arterial hypertension among individuals of 25–64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014; 4: 4–14 (In Russ.)]. doi: https://doi.org/10.15829/1728-8800-2014-4-4-14.

  18. Williams B., Mancia G., Spiering W. et al. ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 39(33): 3021–104. doi: 10.1093/eurheartj/ehy339.

  19. Карпов Ю.А., Горбунов В.М., Логунова Н.А. Применение тройной фиксированной комбинации в лечении артериальной гипертензии – возможность эффективного контроля артериального давления при использовании комбинированной антигипертензивной терапии: основные результаты Российского наблюдательного исследования ТРИКОЛОР. Российский кардиологический журнал. 2020; 10: 4130. [Karpov Yu.A., Gorbunov V.M., Logunova N.A. Triple fixed-dose combination in the treatment of hypertension: the results of the Russian observational study TRICOLOR. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 10: 4130 (In Russ.)]. doi: https://doi.org/10.15829/1560-4071-2020-4130.

  20. Pall D., Szanto I., Szabo Z. Triple combination therapy in hypertension: the antihypertensive efficacy of treatment with perindopril, amlodipine, and indapamide SR. Clin Drug Investig. 2014; 34(10): 701–08. doi: 10.1007/s40261-014-0223-0.

  21. Toth K., PIANIST Investigators. Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). Am J Cardiovasc Drugs. 2014; 14(2): 137–45. doi: 10.1007/s40256-014-0067-2.

  22. Gao Y.S., Nagao T., Bond R.A., Janssens W.J., Vanhoutte P.M. Nebivolol induces endothelium-dependent relaxations of canine coronary arteries. J Cardiovasc Pharmacol 1991;17:964 –9.

  23. Dhakam Z., Yasmin, McEniery C.M. et al. A comparison of atenolol and nebivolol in isolated systolic hypertension. J.Hypertens. 2008; 26(2): 351–56. doi: 10.1097/HJH.0b013e3282f283c9.

  24. Simova I.I., Todorova-Konstantinova R.R., Denchev S.V. Effects of nebivolol versus bisoprolol on endothelial function in hypertensive patients. Exp Clin Cardiol. 2009; 14(4): 45–49.

  25. Ritter J.M. Nebivolol: endothelium-mediated vasodilating effect. J Cardiovasc Pharmacol. 2001; 38 Suppl 3: S13–16. doi: 10.1097/00005344-200112003-00003.

  26. Fratta Pasini A., Garbin U., Nava M.C. et al. Nebivolol decreases oxidative stress in essential hypertensive patients and increases nitric oxide by reducing its oxidative inactivation. J Hypertens. 2005; 23(3): 589–96. doi: 10.1097/01.hjh.0000160216.86597.ff.

  27. Преображенский Д.В., Сидоренко В.А., Алехин М.Н. с соавт. Гипертрофия левого желудочка при гипертонической болезни. Критерии диагностики гипертрофии левого желудочка и ее распространенность. Кардиология. 2003; 10: 99–104. [Preobrazhensky D.V., Sidorenko V.A., Alekhin M.N. et al. Left ventricular hypertrophy in hypertension. Diagnostic criteria for left ventricular hypertrophy and its prevalence. Kardiologiya = Cardiology. 2003; 10: 99–104 (In Russ.)].


About the Autors

Murat A. Umetov, MD, professor, head of the Department of faculty therapy, Kabardino-Balkarian State University named after H.M. Berbekov. Address: 360000, Nalchik, 5 Gorkogo Str. Tel.: +7 (909) 487-78-01. E-mail: umetovma@yandex.ru
Inara A. Khakuasheva, assistant at the Department of faculty therapy, Kabardino-Balkarian State University named after H.M. Berbekov. Address: 360000, Nalchik, 5 Gorkogo Str. Tel.: +7 (928) 708-73-77. E-mail: inara2333@yandex.ru
Magira R. Akkaeva, postgraduate student of the Department of faculty therapy, Kabardino-Balkarian State University named after H.M. Berbekov. Address: 360000, Nalchik, 5 Gorkogo Str. Tel.: +7 (928) 711-22-23. E-mail: magamalkarova@gmail.com
Marina A. Tamazova, postgraduate student of the Department of faculty therapy, Kabardino-Balkarian State University named after H.M. Berbekov. Address: 360000, Nalchik, 5 Gorkogo Str. Tel.: +7 (964) 038-65-99. E-mail: tbb404@mail.ru
Amina Z. Sanova, resident of the Department of faculty therapy, Kabardino-Balkarian State University named after H.M. Berbekov. Address: 360000, Nalchik, 5 Gorkogo Str. Tel.: +7 (906) 251-46-41. E-mail: amina07.00@mail.ru
Darina M. Khakulova, 5th year student of the Faculty of medicine, Kabardino-Balkarian State University named after H.M. Berbekov. Address: 360000, Nalchik, 5 Gorkogo Str. Tel.: +7 (928) 702-82-86. E-mail: khakulova10@gmail.com


Similar Articles

Back to Content

Бионика Медиа