Comparative Efficacy of Olmesartan and Perindopril on the Effect on Central Blood Pressure and Elastic Properties of the Arteries in Patients with Mild to Moderate Hypertension

Yu.N. Sirenko, O.L. Rekovets, S.N. Kushnir

Abstract


Introduction. Central aortic pressure is a precise criterion of target organ damage and cardiovascular mortality compared with brachial artery pressure.
Objective. To compare the efficacy of olmesartan and perindopril in reduction of central aortic pressure and improvement of the elastic properties of arteries in patients with mild to moderate arterial hypertension (AH).
Materials and Methods. We carried out an observation including 40 patients with mild to moderate hypertension (20 men, 20 women). All patients were divided into 2 groups — treatment with perindopril 4–8 mg/daily (n = 20) and olmesartan 20–40 mg/daily (n = 20). When the target blood pressure (BP) levels were no achieved torasemide 5 mg/daily was added. The procedure of examination at baseline and after 6 months included office systolic (SBP) and diastolic (DBP) blood pressure measurements, ambulatory blood pressure monitoring (ABPM), central blood pressure measurement, estimation of pulse wave velocity (PWV) and assess the level of blood lipids.
Results. After 6 months of therapy there was a significant reduction in office systolic and diastolic blood pressure levels in both groups by 30.05/16.25 mmHg in olmesartan group and 30.6/16.10 mmHg in perindopril group. Such significant reduction of office BP may be explained by that after 1 month of treatment, in case of target BP levels were not achieved, torasemide was added.
The level of central SBP was significantly decreased in both groups, about 20.13 ± 5.89 mmHg in the olmesartan group and 16.15 ± 4.59 mmHg in perindopril group. The difference in the central SBP levels was 4 mmHg. In olmesartan group АIх decreased by 8.13 % and by 2.6 % in perindopril group (p < 0.05). For both groups it was shown an improvement of elastic properties of arteries due to PWV reduction in elastic arteries. In olmesartan group PWV in elastic arteries decreased by 2.43 m/s and in perindopril group — by 1 m/s (p > 0.05 between groups, probably due to the small number of observations). In torasemide subgroupы сSBP decrease did not significantly differ, it was 12.43 mmHg for combination olmesartan + torasemide and 13.67 mmHg for combination perindopril + torasemide subgroups. In olmesartan + torasemide subgroup АIх decreased by 14.4 %, and in perindopril + torasemide subgroup it did not change (p < 0.05 between groups). In olmesartan monotherapy, PWV in elastic arteries decreased by 2.72 m/s compared to 0.88 m/s in perindopril monotherapy (p < 0.05 between subgroups).
Conclusion. Central aortic pressure in both groups decreased significantly equally. With the same reduction of office BP and BP in ABPM, in olmesartan group АIх decreased significantly both in monotherapy and in combination with torasemide, compared with perindopril group. PWV decreased in both groups, but in olmesartan monotherapy this decrease was significantly greater compared to perindopril monotherapy.


Keywords


hypertension; olmesartan; perindopril; central aortic pressure; pulse wave velocity

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DOI: https://doi.org/10.22141/2224-1485.5.31.2013.86457

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