The aim – to compare the influence of fixed dose combination of valsartan 160 mg and hydrochlorothiazide (HCTZ) 25 mg (n=33) vs bisoprolol 10 mg and HCTZ 25 mg (n=27) on office, 24-hour and central blood pressure (BP); arterial stiffness and sexual function.
Material and methods. There were included 60 male patients with moderate and severe arterial hypertension (mean systolic BP (SBP)/diastolic BP (DBP) – 167.3±0.8/90.3±0.9 mmHg). Baseline and during treatment measurements of body mass, office BP and heart rate were performed, ambulatory blood pressure monitoring, pulse wave velocity (PWV) measurement on a.carotis – a.femoralis (PWVe) and a.carotis – a.radialis (PWVm) segments, central SBP and pulse BP measurements, biochemical blood analysis, ECG. Sexual dysfunction in men was evaluated by international index of erectile function multidimensional scale. Patients were randomized on two combinations and if target BP was not achieved at 1 month amlodipine (up-titrated to 10 mg) and after 3 months doxazosin were added. Follow-up period was 6 months.
Results. Both combination therapies were effective in office BP lowering (100 and 96.3 % in valsartan and bisoprolol groups respectively, NS), but in bisoprolol group there were used higher doses of amlodipine (59.3 vs 27.3 %) and more frequently doxazosin (11.1 vs 0 %) than in valsartan group. No serious differences between groups regarding decreasing of 24-h BP were noted, but night pulse BP and day-time variability of DBP was lowered only in valsartan group. Both drug strategies were effective in decreasing central SBP, normalization rate was higher on valsartan (90.6 vs 63 %, Р<0.02). Central pulse BP decreased significantly only in valsartan group (from 49.1±3.5 to 35.5±2.8 mmHg, Р<0.01). Despite significant decrease of central SBP, we noted significant increase of augmentation index on bisoprolol from 32.2±1.3 till 36.7±1.3 % (Р<0.05), which may be explained by heart rate decrease. Under valsartan augmentation index did not change significantly (27.2±5.2 to 19.4±1.98 %). Improving of arterial stiffness (i.e., significant decreasing of PWVe) was found only under valsartan. Both combination treatments were metabolic neutral and safe, but adverse reaction rate was higher for bisoprolol (44.4 vs 18.2 %, P<0.05). Valsartan background therapy improved erectile function and total satisfaction in 23.8 % men, while bisoprolol background therapy did not change any sexual parameters. Conclusion. Therapy based on valsartan and HCTZ combination might be preferable than based on bisoprolol and HCTZ combination, especial in patients with higher arterial stiffness and in men with sexual dysfunction.