G.D. Radchenko, O.O. Torbas, Yu.M. Sirenko, G.V. Ponomareva, P.I. Sidorenko, S.A. Polishchuk, O.O. Snitsarenko. Comparison of treatment based on combination lisinopril and hydrochlorothiazide vs bisoprolol and hydrochlorothiazide in patients with moderate to severe arterial hypertension

The aim – to compare the effectiveness of therapy based on combination of beta-blocker bisoprolol and hydrochlorothiazide (B+HCTZ) with a combination of ACEI lisinopril and hydrochlorothiazide (Liz+HCTZ).

Material and methods. The study included 59 patients with moderate to severe arterial hypertension (mean systolic (SBP)/diastolic (DBP) blood pressure was 171.3±2.1/98.6±1.3 mm Hg). All patients at baseline and during follow-up underwent following procedures: weight and height measurements, office SBP, DBP and heart rate measurements, ambulatory BP monitoring (ABPM), determination of the pulse wave velocity in arteries of elastic (PWV(e)) and muscle (PWV(m)) types, central SBP measurement, biochemical blood tests, ECG. Either a fixed combination Liz+HCTZ in a daily dose of 40 and 25 mg respectively (n=32) or a free combination of bisoprolol 10 mg and hydrochlorothiazide 25 mg (n=27) were prescribed. Amlodipine and doxazosin were added after 1 and 3 months of the treatment, if necessary.

Results. The decrease of office SBP/DBP in Liz+HCTZ, and B+HCTZ was similar (by 44.5±1.9/19.0±2.1 and 42.4±2.1/18.8±2.5 mm Hg, respectively, P=NS for difference) in treatment groups. The percentages of patients that achieved target BP on the 1st, 2nd, 3rd and 6th months were 31.2; 53.1; 84.4 and 93.8 % in Liz+HCTZ and 22.2; 48.1; 85.2 and 92.6 % in B+HCTZ groups, respectively. 24SBP/24DBP decreased by 19.0±3.3/19.3±2.8 mmHg in Liz+HCTZ group and by 24.1±1.8/16.9±1.2 mm Hg in B+HCTZ group. Reduction of cSBP in Liz+HCTZ group was significantly higher than in group of bisoprolol-based combination (25.9±2.9 mm Hg vs 15.4±2.9 mm Hg, respectively; P<0.05 for the degree difference of reduction between groups). In B+HCTZ group a significant increase of augmentation index (from 19.7±1.7 % to 24.6±1.5 %; P<0.05) was observed while in Liz+HCTZ group this index was not significantly changed. In Liz+HCTZ PWV(e) decreased by 1.2±0.08 m/s, in B+HCTZ – by 0.63±0.09 m/s, P<0.001 for difference between groups. Conclusions. Despite almost equivalent brachial BP decrease according to office measurement and ABPM data, therapy based on combination of Liz+HCTZ significantly better decreased cSBP. Besides, in this group we observed a significant decrease of serum creatinine concentration at the end of the study.

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