Comparative Efficiency of Enalapril and Perindopril in Terms of the Effect on Central Blood Pressure and Elastic Properties of Arteries in Patients with Mild to Moderate Hypertension
Introduction. Central aortic pressure is a strict criterion of target organ damage and cardiovascular mortality compared with the pressure in the brachial artery.
Objective: to compare the effectiveness of enalapril and perindopril in reducing central aortic pressure and improving elastic properties of arteries in patients with mild to moderate hypertension.
Materials and methods. We conducted surveillance involving 40 patients with mild to moderate hypertension (20 men, 20 women). All patients were divided into 2 groups of perindopril 4–8 mg/day
(n = 20) and enalapril 20–40 mg/day (n = 20) therapy. The procedure of examination at baseline and in 6 months included the measurement of office systolic (SBP) and diastolic blood pressure (DBP), ambulatory blood pressure monitoring (ABPM), evaluation of central blood pressure, pulse wave velocity (PWV) and blood lipids.
Results. After 6 months of therapy, there was a significant reduction in office systolic and diastolic blood pressure in both groups: by 30.60/17.30 mm — in the enalapril group, and by 30.60/16.10 mm — in the perindopril group. BP during daily monitoring decreased effectively and equally in both treatment groups, and SBP/DBP reduction in the enalapril group was 16.78/12.19 mmHg, and in the perindopril group — 18.64/10.11 mmHg.
The level of the central SBP significantly decreased in both groups: in the enalapril group — by 16.40 ± 3.07 mmHg, and in the perindopril group — by 16.15 ± 4.59 mmHg. In the enalapril group, augmentation index decreased by 4.9 %, and in the perindopril group — by 2.6 %. Both groups showed improvement of elastic properties of arteries by reducing PWV in elastic arteries. In the enalapril group, PWV decreased by 0.96 m/s, in the perindopril group — by 1.4 m/s (p > 0.05 between groups, probably due to the small number of cases).
Conclusion. Central systolic blood pressure in both groups reduced significantly equally, with the same lowering of office BP and BP in ABPM. PWV decreased in both groups, but in the group perindopril, this decline was greater in comparison with the enalapril group.
Full Text:PDF (Русский)
Cockcroft J.R. ACE inhibition in hypertension: focus on perindopril // Am. J. Cardiovasc. Drugs. — 2007. — Vol. 7 (5). — P. 303-317.
Dahlöf B., Gosse P., Guéret P. et al. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study // J. Hypertens. — 2005. — Vol. 23 (11). — P. 2063-2070.
De Ciuceis C., Salvetti M., Rossini C. et al. Effect of antihypertensive treatment on microvascular structure, central blood pressure and oxidative stress in patients with mild essential hypertension // J. Hypertens. — 2014. — Vol. 32 (3). — P. 565-574.
de la Sierra A., Gorostidi M., Banegas J.R., Segura J., Vinyoles E., de la Cruz J.J., Ruilope L.M. Ambulatory Blood Pressures in Hypertensive Patients Treated With One Antihypertensive Agent: Differences Among Drug Classes and Among Drugs Belonging to the Same Class // J. Clin. Hypertens (Greenwich). — 2015. — Vol. 17 (11). — P. 857-865.
Frimodt-Møller M., Kamper A.L., Strandgaard S., Kreiner S., Nielsen A.H. Beneficial effects on arterial stiffness and pulse-wave reflection of combined enalapril and candesartan in chronic kidney disease — a randomized trial // PLoS One. — 2012. — Vol. 7 (7). — P. e41757.
Ghiadoni L. Perindopril for the treatment of hypertension // Expert Opin Pharmacother. — 2011. — Vol. 12 (10). — P. 1633-1642.
Ghiadoni L., Bruno R.M., Cartoni G. et al. Combination therapy with lercanidipine and enalapril reduced central blood pressure augmentation in hypertensive patients with metabolic syndrome // Vascul. Pharmacol. — 2015. — Vol. 10. — P. S1537-1891.
Gupta A.K., Nasothimiou E.G., Chang C.L., Sever P.S., Dahlöf B., Poulter N.R. Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk // J. Hypertens. — 2011. — Vol. 29. — P. 2004-2013.
Kechagia I.A., Kalantzi L., Dokoumetzidis A. Extrapolation of enalapril efficacy from adults to children using harmacokinetic/pharmacodynamic modeling // J. Pharm. Pharmacol. — 2015. — Vol. 67 (11). — P. 1537-1545.
London G.M. Arterial calcification: cardiovascular function and clinical outcome // Nefrologia. — 2011. — Vol. 31. — P. 644-647.
Mackenzie I.S., McEniery C.M., Dhakam Z. et al. Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension // Hypertension. — 2009. — Vol. 54. — P. 409-413.
Manisty C.H., Hughes A.D. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index // Br. J. Clin. Pharmacol. — 2013. — Vol. 75. — P. 79-92.
Morgan T., Lauri J., Bertram D., Anderson A. Effect of different antihypertensive drug classes on central aortic pressure // Am. J. Hypertens. — 2004. — Vol. 17 (2). — P. 118-123.
Nedogoda S.V., Ledyaeva A.A., Chumachok E.V. Randomized trial of perindopril, enalapril, losartan and telmisartan in overweight or obese patients with hypertension // Clin. Drug Investig. — 2013. — Vol. 33 (8). — P. 553-561.
Ruilope L.M., Schaefer A. Efficacy of Sevikar® compared to the combination of perindopril plus amlodipine on central arterial blood pressure in patients with moderate-to-severe hypertension: Rationale and design of the SEVITENSION study // Contemp. Clin. Trials. — 2011. — Vol. 32 (5). — P. 710-716.
Ruilope L.M. SEVITENSION Study Investigators. Fixed-Combination Olmesartan/Amlodipine Was Superior to Perindopril + Amlodipine in Reducing Central Systolic Blood Pressure in Hypertensive Patients With Diabetes // The Journal of Clinical Hypertension. — 2015. — Vol. 23. — doi.: 10.1111/jcn.12673
Safar M.E. Effect of angiotensin II blockade on central blood pressure and arterial stiffness in subjects with hypertension // Int. J. Nephrol. Renovasc. Dis. — 2010. — Vol. 3. — P. 167-173.
Tomlinson L.A., Selvarajah V., Wilkinson I.B. Rate-limiting step: can different effects of antihypertensives on central blood pressure be translated into outcomes? // Hypertension. — 2011. — Vol. 57. — P. 1047-1048.
Wang K.L., Cheng H.M., Chuang S.Y. et al. Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? // J. Hypertens. — 2009. — Vol. 27. — P. 461-467.
Williams B., Lacy P.S., Thom S.M. et al. CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study // Circulation. — 2006. — Vol. 113. — P. 1213-1225.
Copyright (c) 2016 HYPERTENSION
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2019