Differential effects of azilsartan-based combinations on arterial stiffness and central hemodynamics in essential hypertension

Background Arterial stiffness and central hemodynamic parameters are independent predictors of cardiovascular risk beyond peripheral blood pressure reduction. The comparative impact of different azilsartan-based combinations on structural and pulsatile components of vascular stiffness remains insufficiently explored. Aim To compare the effects of azilsartan plus nitrendipine (A+N) versus azilsartan plus indapamide (A+I) on carotid–femoral pulse wave velocity (cfPWV), central pulse pressure (cPP), and augmentation index (AIx) in patients with essential hypertension. Methods In this prospective comparative study, patients with essential hypertension received A+N (n=51) or A+I (n=50) for 6 months. Carotid–femoral PWV and central hemodynamic parameters were assessed at baseline and at 6 months using applanation tonometry. Within-group changes and between-group differences in delta values were analyzed. Results Both treatment regimens were associated with significant reductions in cfPWV. In the A+N group, PWV decreased from 10.57 m/s to 7.37 m/s (Δ −3.20 m/s; p<0.000001). In the A+I group, PWV decreased from 9.59 m/s to 7.36 m/s (Δ −2.23 m/s; p<0.00001). The between-group difference in PWV reduction was −0.97 m/s in favor of A+N but did not reach statistical significance (p≈0.08). Reduction in central pulse pressure was greater in the A+N group (Δ −21.52 mmHg vs −13.89 mmHg; p≈0.047). No significant between-group differences were observed for changes in AIx. Conclusion Both azilsartan-based combinations significantly improved arterial stiffness over 6 months. While azilsartan plus nitrendipine showed a numerical trend toward greater PWV reduction and a significantly larger decrease in central pulse pressure, differences in structural stiffness reduction were not statistically significant. These findings suggest broadly comparable effects of the two combinations on vascular stiffness, with a potential differential impact on pulsatile load that warrants further investigation.