Effects of low-dose combination therapy with an angiotensin-converting enzyme inhibitor and a diuretic on flow-mediated vasodilation in hypertensive patients: a 6-month, single-center study

Abstract

Background: Combination therapy with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic has been shown to be highly effective in hypertension. Clinical trials have demonstrated that ACE inhibitors may improve endothelial cell dysfunction in hypertension. However, the effectiveness of the combination treatment in endothelial cell dysfunction is unknown.Objective: This study investigated the effects of a new low-dose combination, perindopril 2 mg plus indapamide 0.625 mg, on brachial artery flow-mediated vasodilation (FMD) and left ventricular diastolic function in hypertension.Methods: Patients aged 18 to 75 with newly diagnosed stage I or II hypertension were eligible. Endothelium-dependent brachial artery FMD and endotheliumindependent vasodilation were assessed at baseline. Patients were treated with oral perindopril 2 mg plus indapamide 0.625-mg tablets once daily for 6 months. FMD measurements were then repeated. Percentage changes in FMD from baseline to 6 months, as well as left ventricular diastolic function parameters (isovolumic relaxation time [IVRT] and mitral diastolic E-wave deceleration time [EDT]), indicated the effectiveness of the intervention.Results: Twenty-nine Turkish patients were enrolled (17 women, 12 men; mean [SD] age, 54.5 [9.5] years [range, 38-75 years]). The mean (SD) baseline FMD was 7.00% (2.39%) (endothelial cell dysfunction) and increased significantly to 8.68% (2.78%) at 6 months (P ϭ 0.02); FMD improved in 15 patients (51.7%). At baseline and 6 months of therapy, mean (SD) IVRT was 101.7 (12.4) ms and 95.5 (7.7) ms, respectively (P Ͻ 0.001), and EDT was 234.7 (33.9) ms and 217.9 (25.6) ms, respectively (P Ͻ 0.001).Conclusions: In this small sample of hypertensive patients, a low-dose combination ACE inhibitor and diuretic significantly improved brachial artery FMD Accepted for publication October 16, 2003October 16, . doi:10.1016October 16, /j.curtheres.2003.005 Reproduction in whole or part is not permitted.0011-393X/03/$19.00Copyright ą 2003 Excerpta Medica, Inc. CURRENT THERAPEUTIC RESEARCHand left ventricular diastolic function. The improvement in FMD values was independent of the stage of hypertension. These findings suggest a relationship between improvement in endothelial cell function and diastolic function. (Curr Ther Res Clin Exp. 2003;64:715-724)

Effects of Perindopril and Hydrochlorothiazide on Selected Indices of Oxidative Stress in the Blood of Elderly Patients With Essential Hypertension

“…We found that both hydrochlorothiazide and perindopril applied as hypertensive therapy to elderly subjects with essential hypertension effectively lowered blood pressure. Similar to other studies, 6,17,43,44 it was shown in the present study that diuretics and ACEI therapies are very efficient in the treatment of essential hypertension in elderly patients.…”

“…Nevertheless, it is worth emphasizing that, in the present study, both perindopril and hydrochlorothiazide significantly increased NO concentrations. Sekuri et al 44 reported a significant improvement in endothelium function after treatment with perindopril and a diuretic (indapamide) applied in combination therapy. However, Higashi et al 8 stressed that ACEI exclusively could improve endothelial function.…”

Comparative Efficacy of Antihypertensive Agents in Flow-Mediated Vasodilation of Patients with Hypertension: Network Meta-Analysis of Randomized Controlled Trial

“…The studies included in our meta-analysis were all RCTs, published until November 2020. The studies were conducted in Italy [ 12 – 19 ], Germany [ 20 ], China [ 21 – 26 ], Turkey [ 27 – 33 ], UK [ 34 ], Brazil [ 35 – 37 ], Greece [ 38 ], Denmark [ 39 ], Korea [ 40 – 45 ], Bulgaria [ 46 ], USA [ 47 ], Chile [ 48 ], and Japan [ 49 – 60 ]. A flow diagram depicting the inclusion process of these studies is shown in Figure 1 .…”