EFFICACY OF AZILSARTAN MEDOXOMIL ON THE DAILY PROFILE OF PERIPHERAL AND CENTRAL ARTERIAL PRESSURE AND ARTERIAL STIFFNESS IN HYPERTENSIVES WITH TYPE 2 DIABETES

Comorbidity of diabetes  mellitus (DM) with arterial hypertension  (AH) leads to four-time increase of cardiovascular risk (CVR). Achievement of target blood pressure (BP) is one of the main strategies of cardiovascular complications  prevention in DM patients.  Efficacy of azilsartan medoxomil is higher than of other drugs from the group.

Aim. To study changes  in peripheral and central BP daily profile andparameters of arterial stiffness in replacement of RAAS blocker as a partof two component  antihypertension  therapy (AHT) by 40 mg azilsartan medoxomil for patients with AH and type 2 DM, with dose titration to 80 mg if target BP not reached.

Material and  methods. Thirty AH+DM2  patients  not  having targetBP<140/85  mmHg on two component  AHT (53% females,  mean age60,4±7,6  y.o.,  40%  smokers).   Replacement   of  RAAS blocker  by azilsartan medoxomil 40 mg with dose increase to 80 mg in 6 weeks if BP  <140/85  mmHg not achieved. Folow-up lasted for 12 weeks. 24-hour profile of peripheral and central BP and parameters of arterial stiffness were assessed with BPLab Vasotens (JSC “Piotr Telegin”). The results were statistically significant in p<0,05.

Results. In 12  weeks  of therapy,  25  patients  (83%) reached   the target peripheral BP<140/85 mmHg. The increase  of azilsartan medoxomil at week 6 was needed  in 11 (37%) patients.  In 12 weeks there  was significant decrease in clinical peripheral  and central  BP (from   160±16/89±9    mmHg   to   125±7/73±6   mmHg  and   from 144±11/84±4  mmHg to 115±9/67±5  mmHg, respectively), decrease of the  mean  daily peripheral  BP by 22/9  mmHg, central  by 18/13 mmHg, mean nocturnal BP by 24/9 mmHg and 19/10 mmHg, respectively.  There  was  significant  decrease  of  daily and  night variability of SBP (from 15±4 to 10±3 mmHg and from 11±3 to 8±2 mmHg, resp.),  decrease of PWV (from 10,2±2,3 to 9,5±2,2 m/s) and augmentation   index  (from  24,6±8,6  to  13±7,0%),  р<0,05  for  all differences.  There were no significant changes  in PP amplification. Improvement of 24-hour  BP (ABPM) led to increase  of the dippers portion: improvement of SI SBP at azilsartan medoxomil was found in 53% cases. There was decrease of the level of morning SBP raise: from 34±13 mmHg to 25±10 mmHg (р<0,05). The drug demonstrated metabolic neutrality and good tolerability.

Conclusion. Replacement  of RAAS by azilsartan medoxomil in AH and DM2 patients  taking bicomponent  AHT leads to achievement  of target clinical BP in 83%  of patients,  normalization of 24-hour  profiles of peripheral  and central  BP and improvement of parameters of arterial stiffness in most patients. Azilsartan medoxomil therapy tolerated good and is metabolically neutral.

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