Potential of Combination Pharmacotherapy in Patients with Arterial Hypertension and Prediabetes: Focus on Organ Protection

Aim    To compare the effects of two combined antihypertensive therapies on indices of the structural and functional state of the left ventricular (LV) myocardium and intrarenal vascular resistance in patients with arterial hypertension (AH) and prediabetes.
Material and methods    The study included 80 patients with poorly controlled AH and prediabetes who were randomized into two groups: patients in group 1 (n=40) received perindopril at a starting dose of 5 mg/day, sustained-release indapamide 1.5 mg/day, and metformin 1000 mg/day; patients in group 2 (n=40) received perindopril 5 mg/day, moxonidine at a starting dose of 0.2 mg/day, and metformin 1000 mg/day. Subsequently, if necessary, the doses of perindopril and moxonidine were titrated to the maximum permissible ones. Prediabetes was diagnosed based on the results of an oral glucose tolerance test. Ultrasound examination of the heart and renal arteries was performed with a SIEMENS ACUSON X 300 ultrasound apparatus (Korea). Statistical analysis was performed using the Statistica 12.0 software (StatSoft Inc., USA).
Results    In both groups after 24 weeks of pharmacotherapy, patients who achieved the target blood pressure had statistically significant and comparable improvements in all studied parameters of the structural and functional state of the LV myocardium and intrarenal vascular resistance. In a comparable number of patients in both groups, the treatment was associated with normalization of the LV myocardial geometry and diastolic function. The combination including moxonidine was associated with a significant decrease in fasting plasma insulin that was more pronounced than with the diuretic treatment.
Conclusion    In patients with AH and prediabetes, the combination therapy including perindopril, metformin and moxonidine provided a significant improvement in the structural and functional state of the LV myocardium and intrarenal vascular resistance comparable to the improvement produced by a combination of perindopril, metformin and sustained-release indapamide. The combination of an ACE inhibitor, biguanide and moxonidine may in some cases be a preferred pharmacotherapy option for patients with AH and early carbohydrate metabolism disorders due to the observed significant metabolic benefits.

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