Effects of combination antihypertensive therapy on intracardiac hemodynamics and blood vessels in patients with coronary heart disease, post-infarction cardiosclerosis and arterial hypertension

Abstract

The aim of the work is to assess the effectiveness of prescribing a fixed-dose combination of amlodipine with the ACE inhibitor lisinopril or with the angiotensin 2 receptor blocker valsartan in patients with coronary artery disease, acute coronary syndrome with hypertensive disease regarding the impact on the structural and functional parameters of the heart and extracranial branches of the brachiocephalic arteries. Materials and methods. General clinical examination of 108 patients with postinfarction cardiosclerosis and hypertension was done within 12 months. The patients were allocated to two groups. Patients in the first group (n = 50) were assigned a fixed-dose combination of lisinopril and amlodipine (20 mg and 5 mg, respectively), and patients in the second group (n = 58) received a fixed-dose combination of valsartan with amlodipine (160 mg and 5 mg, respectively). The patients were monitored for 12 months, including general clinical examinations, measurements of office blood pressure (BP), 24-hour BP monitoring, echo-dopplerographic examination of the heart and brachiocephalic arteries, determination of the composite endpoint. Statistical analysis of the obtained data was performed using Microsoft Excel, IBM SPSS Statistics v.23. Results. A significant difference in echocardiographic data has been proved (p < 0.05) regarding left ventricle (LV) dimensions in both study groups. A significant decrease in the E/A ratio and an insignificant decrease in E/E’ (p > 0.05) have been found in the first group. When analyzing the indicators of diastolic function in the second group, a highly significant (p < 0.05) decrease in E/A, E/E’, IO of the LA has been revealed; data analysis on the morphofunctional state indicators of the extracranial arteries has shown a CIM reduction and a decrease in PSV and RI. Conclusions. Prescriptions of the fixed-dose combination of amlodipine with the ACE inhibitor lisinopril was more effective in terms of the LV measurements (p < 0.05) and LV diastolic function as evidenced by decreased E/A, E/E’ and IO of the LA (p < 0.05) as compared to the data in the group of amlodipine with the angiotensin 2 receptor blocker valsartan. Both fixed-dose combinations were effective in reducing the CIM thickness, decreasing PSV and RI when analyzing the morphofunctional state findings of the extracranial arteries.