Patologìâ (Dec 2017)
Influence of additional risk factors on the antihypertensive efficacy of eprosartan and telmisartan in patients with essential hypertension
Abstract
Objective. The aim of this study is to determine the effect of additional risk factors on blood pressure parameters, cardiovascular remodeling and the state of vegetative balance of the heart rhythm in patients with stage II essential hypertension (EH) under treatment with eprosartan and telmisartan. Materials and methods. The study included 100 patients with stage II essential hypertension (EH), 1–2 degrees with a low and moderate risk of developing cardiovascular complications. The smoker's status was 30.0 %, hypercholesterolemia more than 5 mmol/l – 69.0 %, overweight and obesity – 82.0 % of patients with EH. By randomisation, half of the patients received eprosartan in a daily dose of 600 mg, the rest received telmisartan at a daily dose of 80 mg for 6 months. Before the start of treatment and after 6 months of therapy, all the patients were subjected to the evaluation of general physical examinations, calculation of body mass index, determination of serum TC level, ECG Holter monitoring with analysis of heart rate variability, ambulatory blood pressure monitoring, echocardiography and duplex pulsed wave dopplerography of extracranial and intracranial vessels. Two weeks before the study, the patients did not take any antihypertensive drugs. Results. In patients with EH with additional risk factors using of eprosartan for 6 months is accompanied by a significant decrease in "office" SBP by 30.0 %, DBP by 21.6 %, PBP by 41.4 % and avg. BP by 25.5 %, regression of myocardial hypertrophy and improvement of diastolic function of the left ventricle. Eprosartan demonstrated a high antihypertensive efficacy on the effect on SBP in patients with EH with the presence/absence of tobacco smoking. However, the effect of eprosartan on DBP was better in patients with EH who do not have the status of a smoker. All the patients with EH, regardless of the presence or absence of an elevated level of total cholesterol, reached the target level of SBP under the influence of eprosartan. The antihypertensive effect of eprosartan against SBP was independent of the presence/absence of obesity in patients with EH. Eprosartan resulted in a significant increase in the maximum linear velocity in the left internal carotid artery by 2.8 % and in the vertebrobasilar region by 24.3 %. The total power of the spectrum under the influence of treatment significantly increased by 14.3 %. Antihypertensive therapy with telmisartan within half a year causes a significant decrease in "office" SBP by 24.8 %, DBP by 20.0 %, PBP by 31.8 %, avg. BP by 22.2 % In patients with EH who have/do not have the status of smoker and in all 100 % of patients with normal and elevated total cholesterol telmisartan was equally effective in achieving the target level of SBP. Obesity or its absence also did not significantly affect the effectiveness of antihypertensive therapy with telmisartan in patients with EH. Telmisartan, like eprosartan, causes regression of left ventricular hypertrophy. Telmisartan has a positive effect on carotid blood flow and does not affect the blood flow of the vertebrobasilar region. There were no changes in the parameters of the vegetative balance under the influence of telmisartan. Conclusion. In patients with EH with additional factors of cardiovascular risk using both eprosartan and telmisartan for half a year is accompanied by a significant decrease in blood pressure, regression of myocardial hypertrophy and improvement of diastolic function of the left ventricle, improvement of blood flow in the carotid region. In contrast to telmisartan, eprosartan increases the total power of the heart rate variability spectrum and does not affect the level of total cholesterol. The influence of telmisartan on the blood flow in the vertebrobasilar region is absent. Smoking, obesity, hypercholesterolemia do not reduce the antihypertensive efficacy of telmisartan and eprosartan against SBP and DBP. However, eprosartan is less effective in reducing DBP in patients with EH who smoke.
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