Significance of vascular remodeling and vagosympathetic tone in the implementation of the antihypertensive effect of indapamide retard
- Authors: Iskenderov B.G.1, Lokhina T.V.1, Berenstein N.V.1
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Affiliations:
- Penza Institute for Postgraduate Medical Education – Branch Campus of the RMACPE
- Issue: Vol 30, No 9/10 (2023)
- Pages: 96-103
- Section: Cardiology
- URL: https://journal-vniispk.ru/2073-4034/article/view/275563
- DOI: https://doi.org/10.18565/pharmateca.2023.9-10.96-103
- ID: 275563
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Abstract
Background. There are opinions about various mechanisms of antihypertensive action of indapamide, including modulation of the neurohumoral status and vasodilating effect, which are of interest for evaluating its effectiveness depending on vagosympathetic tone and the severity of vascular remodeling in patients with arterial hypertension (AH).
Objective. Evaluation of the effectiveness of indapamide retard depending on the presence of vascular remodeling and heart rate variability (HRV) in uncomplicated essential hypertension.
Methods. The study involved 75 patients (43 men and 32 women) aged 48 to 60 years (mean age 56.3±6.4 years) with AH I-II degree. Doppler echocardiography, Doppler ultrasound of the brachial artery (BA), 24-hour blood pressure monitoring, and ECG Holter monitoring were performed. The dynamics of BA wall remodeling parameters, endothelium-dependent vasodilation (EDVD) and HRV were determined before and after 6 months of monotherapy with indapamide retard 1.5 mg/day. The patients were divided into 2 groups: 30 patients without signs of structural and functional BA remodeling of the (Group 1) and 45 with BA wall hypertrophy and/or endothelial dysfunction.
Results. It was found that the initial HRV indicators characterizing the sympathetic hyperactivity significantly differed in the compared groups. In addition, indapamide retard had a sufficiently high and comparable antihypertensive effect in both groups. In the 2nd group, however, during therapy with Indapamide retard 1.5 mg/day, there was a significant decrease in the intima-media thickness by an average of 12.8% (P=0.013) and, conversely, an increase in EDVD by an average of 25.4% (P<0.001). As a result, specific peripheral vascular resistance decreased by an average of 17.1% (P=0.002). In both groups, patients with left ventricular hypertrophy showed a significant decrease in the left ventricular myocardium mass index: in the 1st group on average by 10.4% (P=0.021) and in the 2nd group by 13.4% (P=0.007). Changes in HRV parameters during therapy with indapamide retard in both groups were statistically insignificant, although they tended to improve the vagosympathetic balance. A direct correlation was found between the standard deviation of the R-R intervals - SDNN and the EDVD index (r=0.34; p=0.007).
Conclusion. It has been shown that the vasoprotective effect of Indapamide retard depends on the severity of vascular remodeling and/or endothelial dysfunction in patients with essential hypertension, both in the presence and absence of sympathetic hyperactivity.
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##article.viewOnOriginalSite##About the authors
B. G. Iskenderov
Penza Institute for Postgraduate Medical Education – Branch Campus of the RMACPE
Email: iskenderovbg@mail.ru
ORCID iD: 0000-0003-3786-7559
Dr. Sci. (Med.), Professor, Department of Therapy, Cardiology, Functional Diagnostics and Rheumatology
Russian Federation, PenzaT. V. Lokhina
Penza Institute for Postgraduate Medical Education – Branch Campus of the RMACPE
Email: iskenderovbg@mail.ru
ORCID iD: 0000-0002-9493-444X
Russian Federation, Penza
N. V. Berenstein
Penza Institute for Postgraduate Medical Education – Branch Campus of the RMACPE
Author for correspondence.
Email: iskenderovbg@mail.ru
ORCID iD: 0000-0002-1589-2799
Russian Federation, Penza
References
- Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104. doi: 10.1093/eurheartj/ehy339.
- Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российское кардиологическое общество. Российский кардиологический журнал. 2020;25(3):37–86. [Arterial hypertension in adults. Clinical guidelines 2020. Russian Society of Cardiology. Rossiiskii kardiologicheskii zhurnal. 2020;25(3):37–86. (In Russ.)]. doi: 10.15829/1560-4071-2020-3-3786.
- Robinson D.M., Wellington K. Indapamide Sustained Release. A review of its use in the Treatment of Hypertension. Drugs. 2006;66(2):257–71. doi: 10.2165/00003495-200666020-00011.
- Waeber B., Rotaru C., Feihl F. Position of indapamide, a diuretic with vasorelaxant activities, in antihypertensive therapy. Expert Opin Pharmacother. 2012;13(10):1515–26. doi: 10.1517/14656566.2012.698611.
- Недогода С.В., Смирнова В.О., Хрипаева В.Ю. и др. Возможности индапамида ретард в ангиопротекции у пациентов с метаболическим синдромом после терапии тиазидсодержащими комбинациями. Сердце. 2016;15(3):192–26. [Nedogoda S.V., Smirnova V.O., Khripaeva V.Yu., et al. Possibilities of indapamide retard in angioprotection in patients with metabolic syndrome after therapy with thiazide-containing combinations. Serdtse=Heart. 2016;15(3):192–26. (In Russ)]. doi: 10.18087/rhj.2016.3.224.
- Dudenbostel T., Glasser S.P. Effects of Antihypertensive Drugs on Arterial Stiffness. Cardiol Rev. 2012;20(5):257–71. doi: 10.1097/CRD.0b013e31825d0a44.
- Остроумова О.Д., Кочетков А.И., Лопухина М.В. Сосудистая жесткость у пациентов артериальной гипертензией: возможности антигипертензивной терапии. Системные гипертензии. 2016;13(2):17–23. [Ostroumova O.D., Kochetkov A.I., Lopukhina M.V. Vascular stiffness in patients with arterial hypertension: possible antihypertensive therapy. Sistemnye gipertenzii=Syst Hypertens. 2016;13(2):17–23. (In Russ.)]. doi: 10.26442/SG29126.
- London G.M. Efficacy of indapamide 1.5 mg, sustained release, in the lowering of systolic blood pressure. J Hum Hypertens. 2004;18(Suppl. 2):9–14. doi: 10.1038/sj.jhh.1001799.
- Akram J., Sheikh U.E., Mahmood M., et al. Antihypertensive efficacy of indapamide SR in hypertensive patients uncontrolled with a background therapy: the NATIVE study. Curr Med Res Opin. 2007;23(12):29–36. doi: 10.1185/030079907X242674.
- de Andrade P.E., do Amaral J.A.T., Paiva L., et al. Reduction of heart rate variability in hypertensive elderly. Blood Press. 2017;26(6):350–58. Doi: 0.1080/08037051.2017.1354285.
- Mussalo H., Vanninen E., Ikaheimo R., et al. Heart rate variability and its determinants in patients with severe or mild essential hypertension. Clin Physiol. 2008;21(5):594–604. doi: 10.1046/j.1365-2281.2001.00359.x.
- Vinereanu D., Dulgheru R., Magda S., et al. The effect of indapamide versus hydrochlorothiazide on ventricular and arterial function in patients with hypertension and diabetes: results of a randomized trial. Am Heart J. 2014;168(4):446–56. doi: 10.1016/j.ahj.2014.06.010.3.
- Carthy E.R. Autonomic dysfunction in essential hypertension: a systematic review. Ann. Med. Surg. (Lond). 2013;11(3):2–7. doi: 10.1016/j.amsu.2013.11.002.
- Mori H., Saito I., Eguchi E., et al. Heart rate variability and blood pressure among Japanese men and women: a community-based cross-sectional study. Hypertens Res. 2014;37:779–84. doi: 10.1038/hr.2014.73.
- Макаров Л.М., Комолятова В.Н., Куприянова О.О. и др. Национальные российские рекомендации по применению методики холтеровского мониторирования в клинической практике. Российский кардиологический журнал. 2014;2(106):6–71. [Makarov L.M., Komolyatova V.N., Kupriyanova O.O., et al. National Russian guidelines on application of the methods of Holter monitoring in clinical practice. Rossiiskii kardiologicheskii zhurnal. 2014;2(106):6–71. (In Russ.)].
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