Effects of Fixed Dose Combination Azilsartan Medoxomil/Chlortalidone on the Central Bp in Hypertensive Patients With Hfpef

Abstract

Objective: We aimed to study the effects of a fixed AZL-M/CLD combination on central BP in patients with AH and HFpEF. Design and method: This 12-week study evaluated effects of a fixed-dose combination AZL-M/CLD (n = 30) vs non-fixed-dose combinations of iACE/ARB and thiazide/ thiazide-like diuretics (n = 30) on central BP (cBP), arterial stiffness and pulse wave velocity (PWV) in patients with AH and HFpEF. Patients with EF < 50%, significant valvular disease, ACS, permanent AF, neoplasm, eGFR < 30 ml/min/1.73 m2, BMI > 40 kg/m2 were not included. The initial doses could be titrated to meet BP targets during weeks 4 to 12: in 1 group to 40/25 mg, in the control group up to the maximum daily dose. Results: The mean age in the study group was 67 ± 11 years (M ± SD), 36% (10 /30) males, SBP/DBP 140 ± 12/84 ± 9 mmHg (M ± SD), DM 30% (9/30), obesity 61,2% (18/30), paroxysmal AF 20% (6/30), CKD 57% (16/30), eGFR 63 [44.1;72.8]. In the control group: 66 ± 10 years (M ± SD), 40% (12 /30) males, SBP/DBP was 141 ± 11/82 ± 10 mmHg (M ± SD), DM 30% (9/30), obesity 55 % (16/30), paroxysmal AF 26% (7/30), CKD 61% (18/30), eGFR 65 [46.3;76.1]. During observation, the level of pBP in the study group decreased from 140 ± 12/84 ± 9 mmHg to 120 ± 15/71 ± 12 mmHg (p < 0.05); cBP from 131 ± 15/84 ± 10 to 117 ± 14/78 ± 9 mmHg (p < 0.05) and PWV from 11.7 (9.4;13.4) to 10.1 (8.7;12.3) m/s (p < 0.05). The levels of pBP in the control group decreased from 141 ± 11/82 ± 11 mmHg to 128 ± 16/79 ± 9 mmHg (p < 0.05), cBP from 132 ± 14/85 ± 9 to 127 ± 16/82 ± 13 mmHg (p < 0.05), PWV from 11.5 (9.5; 13.6) to 10.2 (9.2.;12.8) m/s p < 0.05. The t-test indicated significant differences between this two groups in peripheral BP, cBP and PWV (p = 0.004, p < 0.01, p < 0,05 respectively). Conclusions: There is significant antihypertensive effect and reduction of arterial stiffness in patients with AH and HFpEF treated with AZL-M/CLD.