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 and parameters of arterial stiffness in replacement of RAAS blocker as a part of 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 target BP<140/85 mmHg on two component AHT (53% females, mean age 60,4±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%), p<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 (p<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.