Comparison of lercanidipine plus hydrochlorothiazide vs. lercanidipine plus enalapril on micro and macrocirculation in patients with mild essential hypertension

Abstract

Dihydropyridine calcium channel blockers may possess antioxidant properties, and might improve micro and macrovascular structure and function. Combination treatment with an ACE inhibitor may have additional advantages, compared with a thiazide diuretic. The aim of the present study is to investigate the effects of a short-term treatment with lercanidipine, and to compare two combination treatments: lercanidipine + enalapril vs. lercanidipine + hydrochlorothiazide on structural alterations in retinal arterioles, on skin capillary density and on large artery distensibility. Thirty essential hypertension patients are included in the study, and treated for 4 weeks with lercanidipine 20 mg per day orally. Then, they were treated for 6 months with lercanidipine + enalapril (n = 15) or lercanidipine + hydrochlorothiazide (n = 15) combinations. Investigations were performed on basal condition, after appropriate wash out of previous treatments, after 4 weeks of lercanidipine monotherapy treatment, and at the end of the combination treatment. Non-invasive measurements of wall-to-lumen ratio (WLR) and other morphological parameters of retinal arterioles were performed using either scanning laser Doppler flowmetry or adaptive optics. Capillary density was evaluated by capillaroscopy, while pulse wave velocity was measured, and central blood pressures were assessed by pressure waveform analysis. A significant improvement of WLR and other indices of retinal artery structure is observed with both technical approaches after treatment with lercanidipine alone, with a further improvement after treatment with lercanidipine + enalapril, while after treatment with lercanidipine + hydrochlorothiazide, the improvement is partially blunted. Central systolic and diastolic blood pressures are similarly reduced by both therapeutic strategies. Capillary density is increased only after treatment with lercanidipine + enalapril. In conclusion, lercanidipine both in monotherapy and in combination with enalapril but not with hydrochlorothiazide is able to improve microvascular structure; on the other hand, a decrease in central blood pressure is observed with both therapeutic combinations

The New Era of Retinal Imaging in Hypertensive Patients

“…Gallo and coworkers 74 found no significant difference between the effects of different classes of antihypertensive treatment on retinal microvascular remodeling, whereas a multivariate analysis by Rosenbaum and coworkers 73 showed that hypertension drug regimen was not an independent predictor of any retinal anatomical indices. In contrast, De Ciuceis and coworkers 79 found a significant reduction in the wall-to-lumen ratio of hypertensive patients after undergoing combined lercanidipine and enalapril treatments over a period of 24 weeks.…”

“…This is because it is tedious to capture AO images and can be exhausting for patients. Furthermore, as the region of analysis in AO imaging is often limited to a single vessel in a limited field of view, usually a segment of the superotemporal arterioles, 3,68,[73][74][75]79 it is difficult to be certain that the changes in that arteriole are reflective of all other retinal vessels. In the future, large field-of-view montages may be attractive and will potentially yield more reliable information on the microcirculatory status.…”

Adaptive optics ophthalmoscopy: a systematic review of vascular biomarkers

“…Ciuceis and coworkers 14 found a significant difference in WLR in hypertensive patients when lercanidipine and enalapril treatments were combined over a period of 24 weeks,…”

Dynamics of Vascular Stiffness and Endothelial Function in Combination Therapy of Heart Failure with Preserved Ejection Fraction

“…Помимо «двойного» вазодилатирующего эффекта (блокирование прямого вазоконстрикторного действия ангиотензина II и активности симпатической нервной системы), ингибиторы АПФ уменьшают потребность миокарда в кислороде и ингибируют высвобождение альдостерона, тем самым снижая внутрисосудистый объем и преднагрузку. С другой стороны, амлодипин, как блокатор медленных кальциевых каналов, являясь мощным вазодилататором артериолярного русла и коронарных артерий, также обладает антиоксидантным действием [13]. За счет ингибирования трансмембранного перехода ионов кальция внутрь гладкомышечных клеток сердца и сосудов амлодипин расширяет периферические артериолы и снижает ОПС (постнагрузку).…”