Markers of cardiovascular aging: effects of multicomponent therapy

Aim

To study the effects of a fixed combination of amlodipine/lisinopril depending on the use of rosuvastatin on the daily changes in peripheral and сentral blood pressure (BP), parameters of arterial stiffness, metabolic parameters, cardiovascular risk and vascular age in hypertensive patients with metabolic syndrome.

Material and methods

we used Vasotens BPLab system for ambulatory monitoring of blood pressure at the brachial artery and aorta and evaluation of arterial stiffness. The risk of cardiovascular events was determined by the ASCORE scale, followed by the assessment of vascular age. The study included 36 patients (47% men, 52.3±9.1 years, 44% of smokers, BMI 31.6±2.1 kg/m2, clinical BP 160.4±9.0/ 102.6±6.5 mm Hg) with arterial hypertension and metabolic syndrome. Patients were treated with a fixed combination of amlodipine/lisinopril at the starting doses of 5 mg/10 mg daily, with doubling of dose after 4 weeks to achieve target office BP < 140/90 mm Hg. All patients were randomized into the two groups and were treated with rosuvastatin (n = 18) or did not receive statin (n = 18). The duration of therapy was 12 months. Differences were considered statistically significant at p<0.05.

Results

After 4 weeks of treatment 26 patients reached the target BP on the starting dose, while in 10 patients it was achieved after doubling of antihypertensive combination dose. Increasing the statin dose from 10 to 20 mg was required in 10 of 18 patients. Treatment with the fixed combination of amlodipine/lisinopril resulted in signficant decrease in central and peripheral BP, pulse wave velocity, vascular age and increase in systolic and pulse BP amplification. Addition of rosuvastatin was associated with more prominent favorable changes in central BP, systolic and pulse BP amplification, pulse wave velocity and vascular age. The risk of cardiovascular events decreased significantly in both groups.

Conclusion

Fixed combination of amlodipine/lisinopril has more significant impact on central BP, particularly at night, that indirectly indicates improvement in the elasticity of aorta. Addition of rosuvastatin to antihypertensive treatment resulted in further improvement of central pulse wave and arterial stiffness, 5-year risk of cardiovascular events and vascular age.

Key words

Arterial hypertension, metabolic syndrome, ambulatory blood pressure monitoring, central blood pressure, augmentation index, arterial stiffness, vascular age, early vascular ageing.