State of a large vessels and microcirculation - a new target for antihypertensive therapy in patients with hypertension and type 2 diabetes
https://doi.org/10.20996/1819-6446-2016-12-1-21-25
Abstract
Aim. To evaluate the effect of 12 weeks of complex therapy with the fixed combination of enalapril and indapamide on indicators of vascular stiffness of large arteries and parameters of skin microcirculation (MC) in patients with arterial hypertension (HT) and diabetes mellitus (DM) type 2.
Material and methods. 30 patients with HT stage II-III in combination with DM type 2 aged 40-70 years were included into the study. The fixed combination of enalapril and indapamide in addition to lipid-lowering and hypoglycemic therapy was prescribed to all patients. Elastic properties of large arteries were assessed by analyzing the pulse wave velocity (PWV) and the calculation of the index of aortic stiffness (IAS). Skin MC and level of glycated hemoglobin (HbA1c) were also determined.
Results. After the 12-week treatment all patients reached the target values of blood pressure (BP). Office systolic and diastolic BP levels decreased by 18.8 and 13.1% (p<0.05 for both), respectively. The treatment did not have a negative effect on glucose metabolism – HbA1C concentration decreased by 2.7%. PWV in the vessels of elastic and muscular types decreased by 10.8 and 10.1% (p<0.05 for both), respectively, and IAS decreased by 27.4% (p<0.05). Significant growth in factor myogenic regulation of MC and reduction in bypass indicator by 21.8% were found.
Conclusion. Combined therapy with the inclusion of a fixed combination of enalapril and indapamide for 12 weeks had a high antihypertensive efficacy and good tolerability in patients with HT and DM type 2. Treatment significantly reduced the vascular stiffness of large arteries and improved the MC indices in these patients.
About the Authors
M. E. Statsenko
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation
Russian Federation
M. V. Derevyanchenko
Volgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 Russia
Russian Federation
Russian Federation
References
1. Smirnov V.V., Mavricheva I.S., Gavrilova A.E. Hypertension in patients with diabetes. Lechashiy vrach 2009; 11: 38-44. In Russian (Смирнов В.В., Мавричева И.С., Гаврилова А.Е. Артериальная гипертензия у больных сахарным диабетом. Лечащий врач 2009;11:38-44).
2. Aoun S., Blacher J., Safar M.E., Mourad J.J. Diabetes mellitus and renal failure: effects on large artery stiffness. J Hum Hypertens 2001; 15 (10): 693-700.
3. Mattace-Raso F., Hofman A., Verwoert G.C. Reference Values for Arterial Stiffness’ Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: «establishing normal and reference values». Eur Heart J 2010;31:2338-50.
4. Gomez-Marcos M.A., Recio-Rodríguez J.I., Patino-Alonso M.C., et al. Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex. BMC Cardiovascular Disorders. 2012; 12: 37.
5. Van Bortel L.M., Laurent S., Boutouyrie P et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012; 30:445-8.
6. Vlachopoulos C., Aznaouridis K., Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55:1318-27.
7. Vasyuk Y.A., Galyavich A.S., Ivanova S.V., et al. Consensus of Russian experts to assess arterial stiffness in clinical practice, the Russian Society of Cardiology, 2015: draft. Available at: http://www.scardio.ru/content/Guidelines/Soglasovannoe_mnenie_arterial_zhestkost.doc. Checked by 02/17/2016 In Russian (Васюк Ю.А., Галявич А.С., Иванова С.В., и др. Согласованное мнение российских экспертов по оценке артериальной жесткости в клинической практике Российское общество кардиологов, 2015: проект. Доступно на: http://www.scardio.ru/content/Guidelines/Soglasovannoe_mnenie_arterial_zhestkost.doc. Проверено 17.02.2016).
8. Townsend R.R., Wilkinson I.B., Schiffrin E.L. et al.; American Heart Association Council on Hypertension. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness. A Scientific Statement from the American Heart Association. J Hypertension 2015;66 (3):698-722.
9. Belenkov Y.N., Privalova E.B. Danilogorskaya S.A., et al. Vascular remodeling in hypertensive patients: diagnostics and correction. Kardiologiia 2012; 52 (6): 62-72. In Russian (Беленков Ю.Н., Привалова Е.В., Данилогорская Ю.А., и др. Ремоделирование сосудистого русла у больных артериальной гипертонией: возможности диагностики и коррекции. Кардиология 2012; 52(6): 62-72).
10. Podzolkov V.I., Bulatov V.A., Son E.A., Makolkin V.I. Antihypertensive efficacy of valsartan, impact on the state of the central hemodynamics and microcirculation: from the point of view of organoprotection. Sistemnye gipertenzii 2004;1:40-3. In Russian (Подзолков В.И., Булатов В.А., Сон Е.А., Маколкин В.И. Антигипертензивная эффективность валсартана, влияние на состояние центральной гемодинамики и микроциркуляции: взгляд с позиций органопротекции. Системные гипертензии 2004;1:40-3).
11. Levy B.I.. Microcirculation in hypertension. A new target for treatment? Circulation 2001; 104: 735-40.
12. Struijker Boudier HAJ. Hypertension and the microcirculation. In: Kaplan N., ed. Hypertension, microcirculation and end organ damage. London.: Lippincott Williams & Wilkins; 2002: 49-55.
13. Makolkin V.I., Podzolkov V.I., Pavlov V.I., Samoilenko V.V. Microcirculation in hypertension. Kardiologiia 2003; 5: 60-7. In Russian (Маколкин В.И., Подзолков В.И., Павлов В.И., Самойленко В.В. Состояние микроциркуляции при гипертонической болезни. Кардиология 2003; 5: 60-7).
14. Yudkin J.S., Forrest R.D., Jackson C.A. Microalbumiuria as predictor of vascular disease in non-diabetic subjects. Islington. Diabetes Surv. Lancet 1988; 2: 530-3.
15. Baumann M., Burkhardt K., Heemann U. Microcirculatory marker for the prediction of renal end points: a prospective cohort study in patients with chronic kidney disease stage 2 to 4. Hypertension 2014; 64(2): 338-46.
16. Wong T.Y. Improving the prediction of hypertensive target organ damage using novel markers: lessons from retinal vascular imaging research. Hypertension 2014; 64(2): 233-4.
17. Karalliedde J., Gnudi L. Future strategies to prevent renal microvascular disease complications in diabetes. Future Cardiol 2008; 4: 77-83.
18. Krentz A.J., Clough G., Byrne C.D. Interactions between microvascular and macrovascular disease in diabetes: pathophysiology and therapeutic implications. Diabetes Obes Metab 2007; 9: 781-791
19. Maric-Bilkan C., Flynn E.R., Chade A.R. Microvascular disease precedes the decline in renal function in the streptozotocin-induced diabetic rat. Am J Physiol Renal Physiol 2012;302(3):F308-15.
20. Lindenmeyer M.T., Kretzler M., Boucherot A., et al. Interstitial vascular rarefaction and reduced VEGFA expression in human diabetic nephropathy. J Am Soc Nephrol 2007; 18: 1765-76.
21. Nawroth P.P, Isermann B. Mechanisms of diabetic nephropathy-old buddies and newcomers part 2. Exp Clin Endocrinol Diabetes 2010; 118: 667-2.
22. Statsenko M.E., Derevyanchenko M.V., Titarenko M.N., Pastukhova O.R. Violations of skin microcirculation in hypertensive diabetic patients according to the stage of chronic kidney disease. Nephrologia 2015;19(5):57-63. In Russian (Стаценко М.Е., Деревянченко М.В., Титаренко М.Н., Пастухова О.Р. Нарушения микроциркуляции кожи у больных с артериальной гипертензией и сахарным диабетом 2-го типа в зависимости от стадии хронической болезни почек. Нефрология 2015; 19(5):57-63).
23. Statsenko M.E, Derevyanchenko M.V. Features of hypertensive patients with type 2 diabetes: a view of the cardiologist. Pharmateka 2013; 16: 52-7. In Russian (Стаценко М.Е., Деревянченко М.В. Особенности ведения пациентов с артериальной гипертензией и сахарным диабетом 2 типа: взгляд кардиолога. Фарматека 2013; 16: 52-7).
24. Statsenko M.E., Derevyanchenko M.V. Correction of endothelial dysfunction in patients with hypertension and type 2 diabetes by combined antihypertensive therapy. Terapevticheskij Arhiv 2014; 86 (8): 90-3. In Russian (Стаценко М.Е., Деревянченко М.В. Коррекция дисфункции эндотелия у больных артериальной гипертензией и сахарным диабетом 2 типа на фоне комбинированной антигипертензивной терапии. Терапевтический Архив 2014; 86(8): 90-3).
25. Statsenko M.E., Derevyanchenko M.V., Ostrovsky O.V., Titarenko M.N. Endothelial dysfunction - a target for combination antihypertensive therapy in hypertensive patients with type 2 diabetes. Terapevticheskij Arhiv 2013:9: 57-62. In Russian (Стаценко М.Е., Деревянченко М.В., Островский О.В., Титаренко М.Н. Дисфункция эндотелия – мишень для комбинированной антигипертензивной терапии у больных артериальной гипертонией с сахарным диабетом 2 типа. Тер Архив 2013; 9: 57-62).
26. Statsenko M.E., Derevyanchenko M.V. Correction of endothelial dysfunction by combined antihypertensive therapy in hypertensive patients with type 2 diabetes. Kardiologiia 2015; 55(3):17-20. In Russian (Стаценко М.Е., Деревянченко М.В. Возможности коррекции дисфункции эндотелия на фоне комбинированной антигипертензивной терапии у больных артериальной гипертонией с сахарным диабетом 2 типа. Кардиология 2015; 55(3):17-20).
27. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J 2013; 34: 2159- 219.
28. Ilyukhin OV, Ilyukhina MV, Kalganova EL, et al. Pulse wave velocity in the assessment of endothelial dysfunction in patients with chronic heart failure of ischemic etiology. Serdechnaya nedostatochnost 2005; 1: 16-8. In Russian (Илюхин О.В., Илюхина М.В., Калганова Е.Л., Иваненко В.В., Лопатин Ю.М. Скорость распространения пульсовой волны в оценке эндотелиальной дисфункции у больных с хронической сердечной недостаточностью ишемической этиологии. Сердечная недостаточность 2005; 1: 16-8).
29. Krupatkin AI, Sidorov VV. Laser Doppler flowmetry of microcirculation. Moscow: Meditsina; 2005. In Russian (Крупаткин АИ, Сидоров ВВ. Лазерная допплеровская флоуметрия микроциркуляции крови. Москва: Медицина; 2005).
30. Morozova T.E., Andrushinina T.B. The combined antihypertensive therapy of hypertension. Consilium Medicum 2008; 10 (12): 10-12. In Russian (Морозова Т.Е., Андрушинина Т.Б. Комбинированная антигипертензивная терапия артериальной гипертензии. Consilium Medicum 2008; 10 (12): 10-12).
31. Vasilyev A.P., Streltsova N.N. Age features of circulation. Regionarnoe krovoobrashhenie i mikrocirkuljacija 2012; 11 (4): 23-7. In Russian (Васильев А.П., Стрельцова Н.Н. Возрастные особенности микрогемоциркуляции. Регионарное кровообращение и микроциркуляция 2012; 11 (4): 23-7).
32. Vasilyev A.P., Streltsova N.N., Sekisova M.A. Functional features microcirculatory pattern in patients with arterial hypertension and their prognostic value. Kardiovaskuljarnaja terapija i profilaktika 2011; 10 (5): 14-9. In Russian (Васильев А.П., Стрельцова Н.Н., Секисова М.А. Функциональные особенности микроциркуляторной картины у больных артериальной гипертонией и их прогностическое значение. Кардиоваскулярная терапия и профилактика 2011; 10(5): 14-9).
Review
For citations:
Statsenko M.E., Derevyanchenko M.V. State of a large vessels and microcirculation - a new target for antihypertensive therapy in patients with hypertension and type 2 diabetes. Rational Pharmacotherapy in Cardiology. 2016;12(1):21-25. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-1-21-25
Views: 888
Email this article 