Choice of an Optimal Blocker of the Renin-Angiotensin-Aldosterone System in Patients With Concomitant Arterial Hypertension and Chronic Obstructive Pulmonary Disease

Objective: to compare hypotensive and pleiotropic effects of angiotensin II receptor blocker (ARB) azilsartan medoxomil (AM) and angiotensin converting enzyme inhibitor (ACEI) fosinopril in patients with concomitant arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Materials and methods. We included in this open study 49 patients with concomitant stage I-II AH and COPD. Initially all patients received hydrochlorothiazide (12.5 mg/day) and various ACEI but target blood pressure levels were not achieved, and these ACEI were withdrawn. By method of closed envelopes, the patients were divided into 2 groups. Patients of group 1 were given ARB АМ, of group 2 - ACEI fosinopril. Methods of investigation were repetitive 24-hour ambulatory blood pressure monitoring (ABPM), spirometry, measurement of mean pulmonary artery pressure (mPAP), study of endothelial function by instrumental and laboratory methods. Results. After 4 weeks of treatment with AM target BP level (<140/90 mm Hg) was achieved in 20 patients (87%), by month 2 BP was normalized in all group 1 patients. After 4 weeks ABPM showed significant decrease of variability of systolic and diastolic BP, according to Doppler echocardiography mPAP lowered in 16 patients (70%), endothelium-dependent vasodilatation (EDVD) rose up to 9.5±1.7%. By month 6 EDVD rose up to 11.9±1.1%. Spirometry after 6 months revealed significant increase of forced expiratory volume in the first second (FEV1) up to 69.06±16.18% of predicted value (p<0.05 compared to baseline). After 4 weeks of treatment with fosinopril (20 mg/day) target BP was achieved in 22 patients (85%). In 2 months BP normalized in 23 patients. In 3 remaining patients the dose was increased up to 40 mg/day and on month 3 BP became normal in all patients. After 4 weeks of treatment ABPM showed significant decrease of variability of systolic and diastolic BP, in 15 patients we observed lowering of mPAP. However, no changes of bronchopulmonary system were observed during treatment with fosinopril. Conclusion. Treatment of patients with AH combined with COPD with AM compared with treatment with fosinopril produced greater positive effect on BP profile. In addition, choice of AM was associated with greater degree of realization of pleiotropic effects.

артериальная гипертония, хроническая обструктивная болезнь легких, дисфункция эндотелия, азилсартана медоксомил, фозиноприл, arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, azilsartan medoxomil, fosinopril

1. Decramer M. Chronic obstructive pulmonary disease and comorbidities. Lancet Respir Med 2013;1 (1):73-83.

2. Calverley P. M, Anderson J. A., Celli B., Ferguson G. T. TORCH Investigators. Thorax 2010;65 (8):719-725.

3. Kokuvi Atsou, Christos Chouaid, and Gilles Hejblum Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review. BMC Med 2011;9:7.

4. ESH/ESC Guidelines for the management of arterial hypertension // European Heart Journal, DOI:10.1093/euro-heartj/eht151; Journal of Hypertension 2013;31 (7):1281-1357.

5. Никитин В. А., Гостева Е. В., Пышнограева Л. В., Васильева Л. В. Комбинированная терапия бисопрололом и амлодипином у больных хронической обструктивной болезнью легких с артериальной гипертензией./Пульмонология 2015;25 (4):440-446

6. Российские рекомендации по диагностике и лечению артериальной гипертонии. Кардиологический вестник 2015;1:5-67.

7. Global Initiative for Chronic Obstructive Lung Diseases (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. Updated 2017. www.goldcopd.org.

8. Podowski M., Calvi C. et al. Angiotensin receptor blockade attenuates cigarette smoke - induced lung injury and rescues lung architecture in mice. J. Clin Invest 2012 Jan;122 (1):229-240.

9. Dahlof B., Devereux R. B., Kjeldsen S. E. et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002;359:995-1003.

10. Stumpe K. O. et al. Comparison of the Angiotensin II Receptor Antagonist Irbesartan With Atenolol for Treatment of Hypertension Blood Press 1998;7:31-37.

11. Ambrosino L. Clinical assessment of endothelial function in patients with chronic obstructive pulmonary disease: a systematic review with meta-analysis. Intern Emerg Med 2017;5:877-885.

12. Стуров Н. В. Органопротективные свойства блокаторов рецепторов ангиотензина II (сартанов). Справочник поликлинического врача 2009;8:31-34.

13. Диагностика и лечение пациентов с артериальной гипертонией и хронической обструктивной болезнью легких. Рекомендации Российского медицинского общества по артериальной гипертонии и Российского респираторного общества. Системные гипертензии 2013;1:5-34.

14. Mordi I., Mordi N., Delles C., Tzemos N. Endothelial dysfunction in human essential hypertension. Journal of Hypertension 2016;34 (8):1464-1472.