THE EFFECT OF STATIN ADDED TO ANTIHYPERTENSIVE THERAPY ON ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS AT HIGH CARDIOVASCULAR RISK

Background. Little is known about the effect of statins addition to standard antihypertensive therapy on blood pressure level and vascular stiffness in high-risk hypertensive patients.

The aim of the study was to assess the dynamics of vascular stiffness in hypertensive patients of high or very high cardiovascular risk under the influence of rosuvastatin addition to combined two-component amlodipine and lisinopril antihypertensive therapy.

Materials and methods. We investigated 60 hypertensive patients who were randomized into two groups: the 1st group received a fixed amlodipine/lisinopril combination, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin. Mean office and ambulatory blood pressure as well as central aortic blood pressure and pulse wave velocity were evaluated in both groups before and after 24-week follow-up period.

Results. At end of follow-up period the office and average daily blood pressure significantly decreased in both groups, with more prominent office diastolic blood pressure decline in the 2nd one. The central aortic blood pressure equally decreased in both groups. The augmentation index significantly reduced in both groups, mostly in the 2nd one. The carotid-femoral pulse wave velocity declined in both groups to the same extent. The carotid-radial pulse wave velocity decreased statistically only in the second group.

Conclusions. Addition of rosuvastatin to a fixed amlodipine/lisinopril combination in high/very high cardiovascular risk hypertensive patients was accompanied by more pronounced decline of diastolic blood pressure and augmentation index, as well as significantly reduction of pulse wave velocity.

1. Ageev FT, Blankova ZN, Samsonova NS. (2018). The effect of changing conventional antihypertensive therapy for a triple fixed combination therapy with rosuvastatin in hypertensive patients with high cardiac risk [Effekt perevoda patsientov s arterial’noy gipertenziey i vysokim serdechno-sosudistym riskom s obychnoy gipotenzivnoy terapii na terapiyu troynoy fiksirovannoy kombinatsiey s rozuvastatinom: issledovanie «AlROZA»]. Kardiologiya, (S3), 46-54. DOI: 10.18087/cardio.2470

2. Blankova ZN, Aslanyan NS. (2017). The effect of combined therapy on the vessel wall in patients with high cardiac risk [Vliyanie kombinirovannoy terapii na sostoyanie sosudistoy stenki u bol’nykh vysokogo serdechno-sosudistogo riska]. Sistemnye gipertenzii, 14 (2), 51-55. DOI: 10.26442/2075-082X_14.2.51-55

3. Drapkina O, Palatkina L, Zyatenkova E. (2012). Pleiotropic effects of statins. Effect on vascular stiffness [Pleyotropnye effekty statinov. Vliyanie na zhestkost’ sosudov]. Vrach, (9), 5-8.

4. Drozdetskiy SI, Kuchin KV. (2016). Possibilities of using two treatment regimen for vascular stiffness correction [Vozmozhnosti korrektsii sosudistoy zhestkosti s ispol’zovaniem dvukh rezhimov terapii]. Mezhdunarodnyy zhurnal serdtsa i sosudistykh zabolevaniy, 4 (9), 25-36.

5. Karoli NA, Rebrov AP, Roshchina AA, Sergeeva VA, Arkhangelskaya EE. (2010). Efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease and bronchial asthma with concomitant arterial hypertension [Effektivnost’ i bezopasnost’ amlodipina maleata u bol’nykh khronicheskoy obstruktivnoy bolezn’yu legkikh i bronkhial’noy astmoy s soputstvuyushchey arterial’noy gipertoniey]. Ratsional’naya farmakoterapiya v kardiologii, 6 (2), 173-178. DOI: 10.20996/1819-6446-2010-6-2-173-178

6. Karpov YuA. (2015). TRIUMVIRATE study: reducing cardiac risk in hypertensive patients using triple combination antihypertensive and lipid-lowering drugs [Issledovanie TRIUMVIRAT: snizhenie riska razvitiya serdechno-sosudistykh oslozhneniy u bol’nykh AG s pomoshch’yu trekhkomponentnoy kombinatsii antigipertenzivnykh i lipidsnizhayushchikh preparatov]. Kardiologiya, 55 (9), 10-15.

7. Klinicheskie rekomendatsii. Diagnostika i lechenie arterial’noy gipertonii. Kardiologicheskiy vestnik, 10 (1), 3-30.

8. Kobalava ZhD, Kotovskaya YuV, Troitskaya EA. (2010). Combination of the rennin-angiotensin system blocker and dihydropyridine calcium antagonist in the treatment of arterial hypertension [Kombinatsiya blokatora reninan-giotenzinovoy sistemy i digidropiridinovogo antagonista kal’tsiya v lechenii arteri-al’noy gipertonii]. Russkiy meditsinskiy zhurnal, (3), 123-126.

9. Protasov KV, Sinkevich DA, Reshina IV, Zhizhko NV, Logovikova SI, Golubeva LV. (2012). Vascular effects of the perindopril arginine and indapamide fixed combination in patients with arterial hypertension [Sosudistye effekty fiksirovannoy kombinatsii perindoprila arginina i indapamida u bol’nykh arterial’noy gipertenziey]. Kardiologiya, (9), 8-14.

10. Asmar R. (2001). Effect of antihypertensive agents on arterial stiffness as evaluated by pulse wave velocity: clinical implications. Am J Cardiovasc Drugs, 1 (5), 387-397.

11. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Ostergren J; ASCOT Investigators. (2005). Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicenter randomised controlled trial. Lancet, 366 (9489), 895-906. DOI: 10.1016/S0140-6736(05)67185-1

12. D’elia L, La Fata E, Iannuzzi A, Rubba PO. (2018). Effect of statin therapy on pulse wave velocity: A meta-analysis of randomized controlled trials. Clin Exp Hypertens, 8, 1-8. DOI: 10.1080/10641963.2017.1411498

13. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H; European Network for Non-invasive Investigation of Large Arteries. (2005). Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J, 27 (21), 2588-2605. DOI: 10.1093/eurheartj/ehl254

14. Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B, Boutouyrie P. (2003) Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke, 34 (5), 1203-1206. DOI: 10.1161/01. STR.0000065428.03209.64

15. Muiesan ML, Salvetti M, Monteduro C, Rizzoni D, Zulli R, Corbellini C, Brun C, Agabiti-Rosei E. (1999). Effect of treatment on flow-dependent vasodilation of the brachial artery in essential hypertension. Hypertension, 33 (1 Pt 2), 575-580.

16. Nürnberger J, Keflioglu-Scheiber A, Opazo Saez AM, Wenzel RR, Philipp T, Schäfers RF. (2002). Augmentation index is associated with cardiovascular risk. J Hypertens, 20 (12), 2407-2414. DOI: 10.1097/01.hjh.0000045501.82010.fa

17. Schaefer CA, Blatzheim AK, Passon SG, Pausewang KS, Schahab N, Nickenig G, Skowasch D, Schueler R, Hammerstingl C, Pingel S. (2017). Modulation of carotid strain by statin therapy in atherosclerosis patients. Vasa, 46 (2), 108-115. DOI: 10.1024/0301-1526/a000596

18. Strazzullo P, Kerry SM, Barbato A, Versiero M, D’Elia L, Cappuccio FP. (2007). Do statins reduce blood pressure: a meta-analysis of randomized, controlled trials. Hypertension, 49 (4), 792-798. DOI: 10.1161/01.HYP.0000259737.43916.42

19. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O’Rourke M; CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. (2006). Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation, 113 (9), 1213-1225. DOI: 10.1161/CIRCULATIONAHA.105.595496

20. Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J. (2006). Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation, 113 (5), 664-670. DOI: 0.1161/CIRCULATIONAHA.105.579342