Динаміка деформаційних властивостей міокарда та с-термінального фрагмента проколагену 1 типу під впливом блокаторів ренін-ангіотензинової системи у чоловіків із гіпертонічною хворобою

Abstract

Abnormal activation of the renin-angiotensin-aldosterone system (RAAS) is one of the cornerstone mechanisms of hypertensive left ventricular (LV) remodeling. The increased RAAS activity leads to cardiac hypertrophy, fibrosis, apoptosis and enhanced oxidative stress. There is insufficient clinical evidence whether RAAS inhibitors can induce regression of myocardial fibrosis. The dynamics of myocardial deformation under antihypertensive treatment is not well established. The aim of the study — to compare the effects of two antihypertensive combinations (perindopril + amiodipine and losartan + amiodipine) on LV myocardial deformation parameters and level of carboxy- terminal propeptide of procollagen type I (PICP) in hypertensive males. Material and methods. 138 patients were divided into 2 groups according to the antihypertensive treatment strategy. The first group included 108 hypertensives on the fixed combination of perindopril and amiodipine. The second group had 30 particapants on combination of losartan and amiodipine. The LV myocardial deformation was assessed by two-dimensional speckle tracking echocardiography. The plasma level of PICP was determined by ELISA. All measurements were performed at baseline and after 6 months of treatment. Results. Perindopril/amlodipine therapy was associated with increases in basal circular strain (baseline: — 18,6±3,98 % versus 6-months: — 19,7±4,65 %; p=0,026) and circular strain rate (baseline: 1,26 (1.13-1.47) s-1 versus 6-months: 1,35 (1,17-1,61) s-1; p=0,049). The perindopril/amlodipine combination reduced significantly PICP (from 109 to 66 ng/ml; p=0,003). The median of percentage change was -51.9%. These findings were associated with regression of LV hypertrophy and improvement of diastolic function. The LV deformation and PICP level remained unchanged in losartan/amlodipine group after treatment. Conclusions. The six-month treatment with fixed-dose combination of perindopril and amiodipine has a pronounced effect on improvement of LV myocardial deformation properties and prevention of excessive cardiac fibrosis compared with a combination of losartan and amiodipine.