Key result
Six-month treatment with ACE inhibitors/ARBs or CCBs significantly decreased brachial and central blood pressure, though CCB therapy led to a more pronounced decrease in central BP in women.
Why the study?
Gender-associated effects of ACE inhibitor/ARB vs CCB-based therapy on hemodynamics, arterial stiffness, and cardiac structure were not well defined in younger hypertensive patients.
Does ACEi/ARB therapy compared to CCB therapy (with optional indapamide) differentially improve arterial hemodynamics, vascular stiffness, and cardiac structure/function in men versus women with uncomplicated arterial hypertension?
RCT (n=157)
blind envelopes
Does ACEi/ARB therapy compared to CCB therapy (with optional indapamide) differentially improve arterial hemodynamics, vascular stiffness, and cardiac structure/function in men versus women with uncomplicated arterial hypertension?
Antihypertensive therapy with ACEi/ARB or CCB demonstrates gender-specific effects on central hemodynamics and cardiac remodeling, suggesting a potential role for sex-tailored hypertension management.
Answers are grounded in this paper and cite their sources.
May favor CCBs for central BP reduction in women; extends RCT evidence for sex-specific antihypertensive effects.
Objective — to compare the gender-associated effects of 6-month (М6) treatment of patients aged < 65 years with arterial hypertension (AH) 1—2 degree using angiotensin-converting enzyme inhibitor (ACE inhibitor) or angiotensin II receptor blocker (ARB) compared with calcium channel blocker (CCB), if necessary — in combination with thiazide diuretic (indapamide) on the parameters of brachial and central blood pressure (BP), arterial stiffness and structural and functional state of the heart.Materials and methods. The study involved 157 patients (84 men and 73 women) aged 35 to 65 years (mean age (53.8 ± 0.64) years) with uncomplicated AH of І—ІІ stage, 1—2 degrees. Patients were randomized by the blind envelopes into 2 groups depending on the administered therapy: in group A patients received ACE inhibitor (perindopril 5—10 mg) or ARB (olmesartan 20—40 mg); in group B they were administered CCB (lercanidipine 5—10 mg). If the target office brachial BP (bBP) (< 140/90 mm Hg) was not reached, the dose of each antihypertensive drugs (AHD) was increased to a full therapeutic level, and on the next step, if needed, indapamide was added in a dose of 25 mg 1 pd. All patients underwent general clinical examinations, brachial blood pressure measurements, a pulse wave analysis and a measurement of the carotid-femoral and carotid-radial pulse wave velocity (PWVfem., PWVrad.) by applanation tonometry, dopplerechocardiography, and calculation method determined the effective arterial (Ea), ventricular elastance (Ees), ventricular-vascular coupling parameter (Ea/Ees).Results and discussion. The study was completed by 137 patients (78 men and 59 women), 71 were from group A (41 men and 30 women), 66 from group B, including 37 men and 29 women. After 6 months of treatment, the following significant results were achieved in all patients: decreased brachial systolic (bSBP), diastolic (bDBP), mean (mBBP) pressure, which were accompanied by a decrease in central systolic (cSBP), diastolic (cDBP), pulse (cPBP), mean (mCBP) pressures, total peripheral vascular resistance (TPVR) (р < 0.01, р < 0.001). Regardless of the type of treatment, the achieved levels of bSBP, bDBP and mBBP were lower in women than in men (p < 0.05; p < 0.01), whereas lower levels of central blood pressure for the period M6 were determined in women, comparatively with men only with CCB-based treatment. The treatment with ACE inhibitors/ARB did not affect the values of pressure (AP) and augmentation index (AIx) in both men and women (p < 0.05). At the same time, CCB-based therapy contributed to the AP decrease in patients of both genders, and the augmentation index normalized at heart rate 75 (AIх75) — only in women (p < 0.01) while maintaining gender differences in M6. PWV rad. and PWV fem. did not differ from the beginning of the study, and after 6 months they decreased equally regardless of treatment and gender (p < 0.05 and p < 0.01). AHD, regardless of the type, did not significantly affect to the structural parameters (wall thickness, left ventricular mass index (LVMI), ejection fraction, LV diastolic function in men and women (p > 0.05), except for a decrease in LVMI in men compared to 9.5 % for CCB (p < 0.05). In all groups after treatment Ea and Ееs were decreased (all p < 0.01, p < 0.001), but the rate of ventricular-vascular coupling parameter Еа/Ees did not change (all p > 0.05).Conclusions. Treatment of patients with 1—2 degrees of AH during 6 months with ACE inhibitors/ARB ± indapamide or CCB ± indapamide, both men and women, resulted in the significant decrease in brachial and central blood pressure. However, regardless of the type of treatment, women achieved lower levels of brachial blood pressure than men. CCB-based therapy, compared to ACE inhibitors/ARB therapy, contributed to more pronounced decreased in central blood pressure in women, decreased the AP both men and women, AIx75 in women. In addition, 6-months antihypertensive therapy using CCB ± indapamide was reduce LVMI on 9.3 %, but only in men, which was not accompanied by changes in diastolic function, regardless of the type of treatment and gender.
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К. П. Лазарєва (2019) conducted an RCT in arterial hypertension (n=157). ACE inhibitor or ARB vs. Calcium channel blocker (lercanidipine 5-10 mg) was evaluated on Parameters of brachial and central blood pressure, arterial stiffness, and structural and functional state of the heart. Six-month treatment with ACE inhibitors/ARBs or CCBs significantly decreased brachial and central blood pressure, though CCB therapy led to a more pronounced decrease in central BP in women.
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