CHOICE OF AN OPTIMAL BLOCKER OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN PATIENTS WITH CONCOMITANT ARTERIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

摘要

Objective: to compare hypotensive and pleiotropic effects of angiotensin II receptor blocker (ARB) azilsartan medoxomil (AM) and angiotensin converting enzyme inhibitor (ACEI) fosinopril in patients with concomitant arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Materials and methods. We included in this open study 49 patients with concomitant stage I-II AH and COPD. Initially all patients received hydrochlorothiazide (12.5 mg/day) and various ACEI but target blood pressure levels were not achieved, and these ACEI were withdrawn. By method of closed envelopes, the patients were divided into 2 groups. Patients of group 1 were given ARB AM, of group 2 ACEI fosinopril. Methods of investigation were repetitive 24 -hour ambulatory blood pressure monitoring (ABPM), spirometry, measurement of mean pulmonary artery pressure (mPAP), study of endothelial function by instrumental and laboratory methods. Results. After 4 weeks of treatment with AM target BP level (140/90 mm Hg) was achieved in 20 patients (87%), by month 2 BP was normalized in all group 1 patients. After 4 weeks ABPM showed significant decrease of variability of systolic and diastolic BP, according to Doppler echocardiography mPAP lowered in 16 patients (70%), endothelium dependent vasodilatation (EDVD) rose up to 9.5 +/- 1.7%. By month 6 EDVD rose up to 11.9 +/- 1.1%. Spirometry after 6 months revealed significant increase of forced expiratory volume in the first second (FEV1) up to 69.06 +/- 16.18% of predicted value (p 0.05 compared to baseline). After 4 weeks of treatment with fosinopril (20 mg/day) target BP was achieved in 22 patients (85%). In 2 months BP normalized in 23 patients. In 3 remaining patients the dose was increased up to 40 mg/day and on month 3 BP became normal in all patients. After 4 weeks of treatment ABPM showed significant decrease of variability of systolic and diastolic BP, in 15 patients we observed lowering of mPAP. However, no changes of bronchopulmonary system were observed during treatment with fosinopril. Conclusion. Treatment of patients with AH combined with COPD with AM compared with treatment with fosinopril produced greater positive effect on BP profile. In addition, choice of AM was associated with greater degree of realization of pleiotropic effects.