Changes in Left Ventricular Remodeling and Carotid Artery Parameters During Telmisartan-Based Combination Therapy in Arterial Hypertension Associated With Cardiorenometabolic Disorders

Resume. Objective. To compare the effects of telmisartan-based combination antihypertensive therapy with and without moxonidine on hemodynamic parameters, left ventricular remodeling, and carotid artery intima–media thickness over 24 weeks. Materials and methods. This open-label comparative prospective study included 120 patients aged 40–75 years with arterial hypertension (AH) presenting to the outpatient clinic of the Bukhara Regional Branch of the Republican Specialized Scientific and Practical Medical Center of Cardiology. In group 1 (n=60), moxonidine 0.2–0.4 mg/day was added to telmisartan, with amlodipine titrated when treatment targets were not reached. Group 2 (n=60) received telmisartan combined with amlodipine, with hydrochlorothiazide (Hypothiazide) added if target blood pressure (BP) was not achieved. Patients underwent comprehensive assessments before treatment and after 24 weeks. Office and automated measurements included systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP), and heart rate (HR). Left ventricular mass (LVM) was calculated using the Devereux formula. Left ventricular mass index (LVMI), relative wall thickness (RWT), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), Simpson’s method ejection fraction (EF), E/A ratio, left atrial volume (LAV), and left atrial volume index (LAVI) were determined. Duplex carotid ultrasonography was used to measure the intima–media thickness (IMT) of the left and right common carotid arteries. Within-group paired comparisons were performed using the paired Student’s t-test for parametric distributions or the Wilcoxon test for nonparametric distributions. Between-group comparisons used the independent-samples Student’s t-test or Mann–Whitney U test, and categorical variables were evaluated with the χ² test. Results. Before treatment, the groups were compared with respect to their main clinical, hemodynamic, echocardiographic, and laboratory characteristics. Left ventricular hypertrophy was identified in 40 patients (66.7%) in group 1 and 42 patients (70.0%) in group 2 (p=0.695). Eccentric left ventricular hypertrophy was the predominant geometric pattern, with frequencies of 41.7% and 43.3%, respectively (p=0.853). After 24 weeks, BP decreased significantly in both groups, with a more pronounced change in group 1: SBP was 118.44±5.67 versus 122.00±6.44 mmHg in group 2 (p=0.0017), and DBP was 76.40±5.79 versus 79.42±5.40 mmHg, respectively (p=0.0038). At 24 weeks, BP, LVM, LVMI, RWT, and carotid IMT had decreased significantly in both groups. LVMI declined from 110.56±27.68 to 99.68±21.29 g/m² in group 1 and from 117.65±30.96 to 107.75±21.48 g/m² in group 2; the final between-group difference was p=0.0409. Target automated SBP <130 mmHg was achieved by 93.3% of group 1 and 78.3% of group 2 (p=0.0185). Carotid IMT showed a similar favorable trajectory with both treatment regimens. Conclusion. In patients with arterial hypertension and cardiorenometabolic disorders, both stepwise telmisartan-based combination regimens were associated over 24 weeks with effective BP control, partial regression of left ventricular remodeling, improved systolic and diastolic function, and reduced carotid artery intima–media thickness. These findings indicate that treatment effectiveness in hypertension with a cardiorenometabolic phenotype should be evaluated comprehensively, not only by BP levels but also by changes in cardiac remodeling and vascular, renal, and metabolic markers.