Optimizing antihypertensive therapy in postmenopausal women with metabolic syndrome

Aim. To compare the effects of antihypertensive medications (AHM) on central hemodynamics, metabolic profile, insulin resistance (IR), oxidant and antioxidant systems in postmenopausal patients with metabolic disturbances and Stage I-II arterial hypertension (AH).

Material and methods. The study included 47 postmenopausal women with metabolic syndrome (MS) and Stage I-II AH. Group I (n=31) received an ACE inhibitor spirapril (6 mg/d) for 6 months. Group II (n=16) received various AHM administered as a part of ambulatory therapy. At baseline and after 6 months of the treatment, all participants underwent 24-hour blood pressure monitoring (BPM), echocardiography, lipid profile (LP) and IR index HOMA assessment, oral glucose tolerance test, double energy X-ray absorptiometry with general and regional analysis of body composition, as well as the measurement of lipid acylhydroperoxide levels and erythrocyte superoxide dismutase activity.

Results. In both groups, target BP levels were achieved. In Group I, left ventricular myocardial mass index (LVMMI) significantly decreased (р<0,001). In Group II, only a tendency towards LVMMI reduction was observed (р=0,062). Body mass index and visceral fat tissue percentage increased in both groups. Spirapril therapy was associated with increased levels of high-density lipoprotein cholesterol, HDL-CH (p=0,001), and decreased concentration of triglycerides (р=0,03). In Group II, no LP dynamics was observed, while IR increased. Spirapril therapy was associated with IR index (HOMA) normalisation (р<0,001) and improved oxidant-antioxidant bal¬ance (р<0,001), with no similar changes in Group II.

Conclusion. Spirapril demonstrated beneficial effects on carbohydrate and lipid metabolism, IR and oxidant-antioxidant parameters, as well as cardioprotective activity.

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