FIXED COMBINATION OF VALSARTAN AND AMLODIPINE: EFFECTS ON THE LEFT VENTRICULAR HYPERTROPHY REGRESSION, ALBUMINURIA REDUCTION AND ENDOTHELIUM FUNCTION IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME
https://doi.org/10.20996/1819-6446-2010-6-5-652-656
Abstract
Aim. To study effects of fixed combination of valsartan and amlodipine on of left ventricular hypertrophy (LVH) regression, microalbuminuria reduction and endothelium function in hypertensive patients with metabolic syndrome (MS).
Materials and methods. 20 hypertensive patients (15 females and 5 males) with metabolic syndrome and a history of previous ineffective antihypertensive therapy were studied. Combined antihypertensive therapy was applied during 12-24 weeks. Amlodipine and valsartan dose was 5/160 or 10/160 mg/day depending on blood pressure level. Endothelial function, blood pressure level, urinary albumin excretion and LVH regression were estimated.
Results. Blood pressure reduction to the target level was revealed. There was a significant reduction in microalbuminuria by -55.3±39.2% (р=0.022) in comparison with the baseline. Endothelium-dependent vasodilation increased in 3.6±7.2% (р=0.05) in comparison with baseline, LVH decreased by -9.1±12.4 g/m2 (р=0.021).
Conclusion. Therapy with fixed combination of valsartan and amlodipine results in blood pressure and microalbuminuria reduction, endothelium-dependent vasodilation improvement, LVH regression in hypertensive patients with MS. These findings show that the fixed combination of these antihypertensives has a multifaceted impact on cardiovascular risk.
About the Authors
Ye. I. TarlovskayaRussian Federation
K.Marxa ul. 112, Kirov, 610027
N. S. Maksimchuk
Russian Federation
K.Marxa ul. 112, Kirov, 610027
I. Ye. Sapozhnikova
Russian Federation
K.Marxa ul. 112, Kirov, 610027
S. V. Malchikova
Russian Federation
K.Marxa ul. 112, Kirov, 610027
References
1. Gu Q., Dillon C.F., Burt V.L., Gillum R.F. Association of hypertension treatment and control with all-cause and cardiovascular disease mortality among US adults with hypertension. Am J Hypertens 2010;23(1):38-45.
2. Dendorfer A., Dominiak P., Schunkert H. ACE inhibitors and angiotensin II receptor antagonists. Handb Exp Pharmacol 2005; 170: 407-442.
3. Luscher T.F., Noll G. The pathogenesis of cardiovascular disease: role of the endothelium as a target and mediator. Atherosclerosis 1995; 118(Suppl):S81-90.
4. Ochodnicky P., Henning R.N., vanDokkum R.P., de ZeeuwD.Microalbuminuria and endothelial dysfunction: emerging targets for primary prevention of end-organ damage. J Cardiovasc Pharmacol 2006;47 Suppl 2:S151-62.
5. Taddei S., Virdis A., Chiadoni L., Salvetti A. The pivotal role of endothelium in hypertension. Medicographia 1999; 21(1): 22-29.
6. Feldsherova N.A., Semernin E.N.Amlodipine: a review of clinicaltrials. Kachestvennaya klinicheskaya praktika 2002; 2: 27-33. Russian (Фельдшерова Н.А., Семернин Е.Н. Амлодипин: обзор клинических исследований. Качественная клиническая практика 2002; 2: 27-33).
7. Kremkova M.M., Grachev A.V., Alyavi B.A. Valsartan and lisinopril influence on brachial artery endothelial function in patients with Q-wave acute myocardial infarction. Russian Cardiology Journal 2005; 1: 55-59. Russian (Кремкова М.М., Грачёв А.В., Аляви Б.А. Сравнительная оценка влияния валсартана и лизиноприла на эндотелиальную функцию плечевой артерии у больных острым инфарктом миокарда с зубцом Q. Российский кардиологический журнал 2005; 1: 55-59).
8. TzemosN., LimP.O.,Mac Donald T.M. Nebivololreverses endothelialdysfunctioninessentialhypertension: a randomized, double-blind, crossover study. Circulation 2001;104(5):511-4.
9. Lopez B.L., Christopher T.A., Yue T.L. et al. Carvedilol, a new beta-adrenoreceptor blocker antihypertensive drug, protects against free-radical-induced endothelial dysfunction. Pharmacology 1995;51(3):165-73.
10. Ripp T.M., Mordovin V.F., Pekarsky S.E. Indapamide Retard and Enalapril in Patients With Arterial Hypertension: Hypotensive Efficacy and Effect on Endothelial Function. Cardiology 2007; 4: 45-50. Russian (Рипп Т.М., Мордовин В.Ф., Пекарский С.Е. Гипотен- зивная эффективность и влияние на функцию эндотелия индапамида ретард и эналаприла у больных артериальной гипертонией. Кардиология 2007; 4: 45-50).
11. Higashi Y., Sasaki S., Nakagawa K. et al. Comparison of ACE Inhibitors, Calcium Antagonists, Blockers, and Diuretic Agents on Reactive Hyperemia in Patients with Essential Hypertension: A Multicenter Study. J Am Coll Cardiol 2000; 35(2): 284-291.
12. Dupliakov D.V., Glukhova V.L., Vozhdaeva Z.I., Golovina G.A. Cardioselective betaadrenoblockers in patients with stable angina pectoris. Comparison of efficacy and safety. Ter Arkh 2006;78(9):43-8. Russian (Дупляков Д.В., Глухова В.Л., Вождаева З.И. и др. Сравнительная оценка эффективности и безопасности кардиоселективных β- блокаторов у больных со стабильной стенокардией. Терапевтический архив 2006; 78(9): 43-49).
13. Thijs L., Richart T., de Leeuw P.W. Morbidity and mortality on combination versus monotherapy: a posthoc analysis of the Systolic Hypertension in Europe trial. J Hypertens 2010;28(4):865-74.
14. Mochizuki S., Dahlof B., Shimizu M. et al. for the Jikei Heart Study group. Valsartan in a Japanese population with hypertension and other cardiovascular disease (JikeiHeart Study): a randomised, open-label, blinded endpoint morbidity-mortality study. Lancet 2007; 369(9571): 1431–39.
15. Sawada T., Takahashi T., Yamada H. et al. for the KYOTO HEART Study Group. Rationale and design of the KYOTO HEART study: effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high risk of cardiovascular events. J Hum Hypertens 2009;23(3):188-95.
16. Lishnevskaya V.Yu., Korushko O.V., Bodretskaya L.A. et al. Combination therapy of hypertension in the elderly. Meditsina neotlozhnykh sostoyaniy 2007; 1(8):7-14. UA (Лишневская В.Ю., Корушко О.В., Бодрецкая Л.А. и др. Комбинированная терапия артериальной гипертензии у лиц пожилого возраста. Медицина неотложных состояний 2007; 1(8):7-14).
17. Diagnosis and treatment of metabolic syndrome. Russian guidelines. Kardiovaskulyarnaya terapiya i profilaktika 2007;6 (6) Prilozhenie 2; 1-32. Russian (Диагностика и лечение метаболического синдрома. Российские рекомендации (второй пересмотр). Комитет экспертов ВНОК и РМОАГ. Кардиоваскулярная терапия и профилактика 2007;6 (6) Приложение 2; 1-32).
18. СelermajerD., Sorensen K., GoochV. et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340(8828): 1111-1115.
19. GalyavitchA.S.,Khamidullina A.R., Galyavitch R.A. Effect of Antihypertensive Drugs on Some Humoral Parameters of Endothelial Function. Cardiology 2009; 5: 30-33. Russian (Галявич А.С., Хамидуллина А.Р., Галявич Р.А. Влияние антигипертензивных средствнанекоторые гуморальные показатели функции эндотелия. Кардиология 2009;5:30-33).
20. Koh K.K., Han S.H., Ahn J.Y. et al. Amlodipine improves endothelial function and metabolic parameters in patients with hypertension . Int J Cardiol 2008;133(1):23-31.
21. Ivanova O.V., Balakhonova T.V., Soboleva G.N. The state of endothelium depended dilation of brachial artery in hypertensive patients, as measured by ultrasound high-resolution. Cardiology 1997; 7: 41-47. Russian (Иванова О.В., Балахонова Т.В., Соболева Г.Н. и др. Состояние эндотелий-зависимой дилатации плечевой артерии у больных гипертонической болезнью, оцениваемое с помощью ультразвука высокого разрешения. Кардиология 1997; 7: 41-47).
22. Muiesan M.L., Salvetti M., Paini A. et al. Prognostic role of flow-mediated dilatation of the brachial artery in hypertensive patients. J Hypertens 2008;26(8):1612-1618.
23. Jones C.A., Francis M.E., Eberhardt M.S. et al. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey.Am JKidneyDis 2002; 39(3): 445-459.
24. Patel B.V., Remigio-Baker R.A., Mehta D. et al. Effects of initial antihypertensiove drug class on patient persistence and compliance in a usual-care setting in the United States. J Clin Hypertens (Greenwich) 2007;9 (9):692-700.
25. Nishiyama A., Kim-Mitsuyama S. New approaches to blockade of the renin-angiotensinaldosterone system: overview of regulation of the renin-angiotensin-aldosterone system. J Pharmacol Sci 2010;113(4):289-91.
26. Wolf G. Molecular mechanisms of angiotensin II in the kidney; emerging role in the progression of renal disease: beyond haemodynamics. Nephrol Dial Transplant 1998; 13 (5):1131-1142.
27. Mason R.P. Mechanisms of plaque stabilization for the dihydropyridine calcium channel blocker amlodipine: review of evidence. Atherosclerosis 2002; 165(2): 191-200.
28. Godfraind T., Salomone S. Calcium antagonists and endothelial function: focus on nitric oxide and endothelin. Cardiovasc Drugs Ther 1996; 10(4): 439-446.
29. Takase H., Moreau P., Kung C.F. et al. Antihypertensive therapy prevents endothelial dysfunction in chronic nitric oxide deficiency. Effect of verapamil and trandalopril.Hypertension 1996; 27(1): 25-31.
30. Nebieridze D.V., Safarjan A.S., Metelskaya V.A. et al. The antihypertensive efficacy of diltiazem and its influence on endothelium function in men with mild or moderate arterial hypertension. Kardiovaskulyarnaya terapiya i profilaktika 2004; 3(1): 4-9. Russian (Не- биеридзеД.В., Сафарян А.С.,Метельская В.А.идр. Антигипертензивная эффективность дилтиазема и его влияние на эндотелиальную функцию у мужчин с мягкой и умеренной артериальной гипертонией. Кардиоваскулярная терапия и профилактика 2004; 3(1): 4-9).
31. Pepine C.J. The role of calcium antagonists in ischemic heart disease. Eur Heart J 1995; 16 (Suppl H):19-24.
32. Effect of nifedipine and cerivastatine on coronary endothelial function in patients with coronary artery disease. The ENCORE I Study. (Evaluation of Nifedipine and Cerivaststine On Recovery of coronary Endothelial Function). Circulation 2003; 107(3): 422-428.
33. Pepine C.J., Handberg E.M., Cooper-DeHoff R.M. et al.; INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronaryartery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003; 290(21): 2805-16.
34. Klingbeil A.U., Schneider M., Martus P. et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003;115(1):41-46.
Review
For citations:
Tarlovskaya Ye.I., Maksimchuk N.S., Sapozhnikova I.Ye., Malchikova S.V. FIXED COMBINATION OF VALSARTAN AND AMLODIPINE: EFFECTS ON THE LEFT VENTRICULAR HYPERTROPHY REGRESSION, ALBUMINURIA REDUCTION AND ENDOTHELIUM FUNCTION IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME. Rational Pharmacotherapy in Cardiology. 2010;6(5):652-656. (In Russ.) https://doi.org/10.20996/1819-6446-2010-6-5-652-656