Key result
ACE inhibitors reduce all-cause mortality ~10% in uncomplicated hypertension, while AT1 blockers show no benefit.
Why the study?
Does initial treatment with fixed-dose combinations of ACE inhibitors and calcium channel blockers improve blood pressure control and reduce cardiovascular mortality in patients with arterial hypertension compared to monotherapy or AT1 blockers?
Does initial treatment with fixed-dose combinations of ACE inhibitors and calcium channel blockers improve blood pressure control and reduce cardiovascular mortality in patients with arterial hypertension compared to monotherapy or AT1 blockers?
Initial treatment of arterial hypertension should preferably utilize fixed-dose combinations of ACE inhibitors and calcium channel blockers to rapidly achieve blood pressure control and reduce long-term cardiovascular mortality.
May favor ACE inhibitors over AT1 blockers for mortality reduction in uncomplicated hypertension; leaves open confirmation by randomized trials.
PrimĂĄrnĂm cĂlem lĂŠÄby arteriĂĄlnĂ hypertenze je vedle dosaĹženĂ optimĂĄlnĂ kontroly krevnĂho tlaku pĹedevĹĄĂm snĂĹženĂ kardiovaskulĂĄrnĂho (KV) rizika a celkovĂŠ mortality. BlokĂĄda systĂŠmu renin‑angiotenzin‑aldosteron (RAAS) je v souÄasnĂŠ dobÄ zĂĄkladem lĂŠÄby hypertonikĹŻ. Ĺada morbi-mortalitnĂch studiĂ prokĂĄzala dlouhodobĂ˝ kardioprotektivnĂ efekt inhibitorĹŻ angiotenzin konvertujĂcĂho enzymu (ACEÂ‑I), kterĂ˝ pĹesahuje ĂşroveĹ samotnĂŠho poklesu krevnĂho tlaku. MetaanalĂ˝za, kterĂĄ porovnĂĄvala ĂşÄinky ACEÂ‑I a AT1 blokĂĄtorĹŻ u hypertonikĹŻ, dospÄla k zĂĄvÄru, Ĺže zatĂmco ACEÂ‑I sniĹžujĂ celkovou mortalitu, AT1 blokĂĄtory efekt na celkovou mortalitu nemajĂ. Z patofyziologickĂŠho hlediska je pĹĂznivĂ˝ efekt ACEÂ‑I na KV prognĂłzu vysvÄtlovĂĄn zvýťenou hladinou cirkulujĂcĂho bradykininu spojenou s dalĹĄĂ vazodilatacĂ a souÄasnĂ˝m snĂĹženĂm stimulace AT2 a AT4 receptorĹŻ. CelkovÄ tak ACEÂ‑I (a zejmĂŠna perindopril) vĂ˝znamnÄ pĹispĂvajĂ k ochranÄ cĂŠvnĂho endotelu, omezenĂ aterogeneze a prevenci rozvoje remodelace myokardu. (Dvou)kombinace lĂŠÄiv, a to preferenÄnÄ fixnĂ, je dnes jiĹž zlatĂ˝m standardem lĂŠÄby arteriĂĄlnĂ hypertenze, a mÄla by bĂ˝t pouĹžita v iniciĂĄlnĂm kroku medikamentĂłznĂ terapie vÄtĹĄiny hypertonikĹŻ. DĹŻvodem je rychlejĹĄĂ dosaĹženĂ optimĂĄlnĂ kontroly krevnĂho tlaku a vyĹĄĹĄĂ mĂra adherence k lĂŠÄbÄ. NejvĂce preferovanou dvoukombinacĂ je podĂĄvĂĄnĂ ACEÂ‑I s blokĂĄtorem kalciovĂŠho kanĂĄlu. JejĂ vĂ˝znamnou vĂ˝hodou je komplementĂĄrnĂ antihypertenznĂ ĂşÄinek, dobrĂĄ tolerance a evidence o spolehlivĂŠm snĂĹženĂ KV rizika a mortality, a to aĹž v horizontu 20 let. NaĹĄi pacienti tak zĹŻstĂĄvajĂ na zavedenĂŠ lĂŠÄbÄ dĂŠle a bez KV komplikacĂ.
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Alena Krajčoviechová (2024) conducted a review in Arterial hypertension. ACE inhibitors vs. AT1 blockers was evaluated on All-cause mortality. ACE inhibitors reduce all-cause mortality by 10% in uncomplicated hypertensive patients, whereas AT1 blockers have no effect on mortality.
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