Possibilities of Azilsartan Medoxomil for Preparation for Planned Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus.

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2024-07-31 DOI:10.18087/cardio.2024.7.n2671

A M Kochergina, O L Barbarash

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Abstract

Aim: To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM).

Material and methods: The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP ≥130 mmHg, mean daily diastolic BP ≥80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg/day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured.

Results: During the azilsartan treatment, GFR decreased by 7.4%, while in the control group, it decreased by 18.9% (p<0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9%. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9%), while in patients of the control group, IL-18 increased (7.14%). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5%, while in patients of the control group, it increased by 96.15%. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1.

Conclusion: This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.

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阿齐沙坦美多米用于 2 型糖尿病患者经皮冠状动脉介入治疗前准备的可能性

目的：评估阿齐沙坦酯用于缺血性心脏病（IHD）、动脉高血压（AH）和2型糖尿病（DM）患者术前准备和改善择期经皮冠状动脉介入治疗（PCI）长期预后的有效性和安全性：研究样本包括转诊择期PCI的2型糖尿病患者，根据24小时血压监测（24-BPM），这些患者的血压（BP）控制不佳（日平均收缩压≥130 mmHg，日平均舒张压≥80 mmHg）。数据收集时间为 2018 年至 2020 年。研究共纳入75名患者，并通过简单随机的方式将其分为两组：第1组（主要组，人数=37）接受阿齐沙坦酯甲钴胺作为降压药物，剂量为40毫克/天（之前处方的血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂（ARB）停用）；第2组（对照组，人数=38）继续之前的降压治疗。随访期为 6 个月。在连续5次随访中，每次都对患者进行检查，记录24-BPM，并测量肾功能不全的尿液指标（肾小球滤过率，GFR；中性粒细胞明胶酶相关脂质钙蛋白，NGAL；尿白蛋白-肌酐比值，UACR；肾损伤分子，KIM-1；白细胞介素-18，IL-18）：结果：阿齐沙坦治疗期间，肾小球滤过率下降了 7.4%，而对照组下降了 18.9%（p<0.001）。随访 6 个月，主要治疗组的 NGAL 浓度没有变化，而对照组的 NGAL 浓度增加了 12.9%。服用阿齐沙坦后，尿液中的 IL-18 浓度下降了 16.9%，而对照组患者的 IL-18 浓度上升了 7.14%。两组患者都出现了蛋白尿，这在患有糖尿病的情况下是可以预料到的；但是，接受阿齐沙坦治疗的患者的 UACR 值增加了 37.5%，而对照组患者的 UACR 值增加了 96.15%。这些差异具有统计学意义。胱抑素 C 和 KIM-1 的浓度在统计学上没有明显差异：这项研究证明了两个重要事实：使用新的、更敏感的肾脏损伤标记物诊断造影剂诱发的急性肾损伤（CI-AKI）的可能性，这对评估预防效果非常重要；使用 ARBs，尤其是阿齐沙坦，预防合并有 AH 和 DM 的 IHD 患者发生 CI-AKI 的可能性。

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.

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