Hypertension: ACEIs more effective in BP control and central hemodynamic improvement than ARBs, finds KGMU study
New Delhi: High Blood Pressure (BP) patients treated with ACEIs versus ARBs showed a more effective improvement with ACEIs in the majority of central hemodynamic parameters (a measure of cardiovascular health), including vascular age, according to a recent study performed on Indian Patients
The study has also suggested that Central aortic blood pressure (CABP) should be used in routine practice for achieving the optimal management of hypertension. The results of the study have been published in the Cardiovascular Therapeutics.
Hypertension is a global pandemic and a major cause for premature death globally affecting nearly 26% of the world population. It is a primary modifiable risk factor for stroke and cardiovascular disease. In India, hypertension continues to be a major public health problem affecting about 29.8% of the population.
Though brachial blood pressure is used for hypertension measurement conventionally, recent research says that central aortic blood pressure can predict cardiovascular events better than brachial blood pressure. To treat hypertension, there is a multitude of drugs that show their effect through different modes of action. Even though these drugs show a similar effect on brachial blood pressure, it was found from research that they have different effects on central blood pressure.
These effects are being studied worldwide but the data in Indian settings are scarce. This is due to the limited use of CABP as a prognostic tool in routine practice.
With this idea, doctors from the Department of Cardiology, King George Medical University, Lucknow conducted a study to evaluate the effects of various antihypertensive drugs on central aortic blood pressure indices in hypertensive outpatients in routine clinical practice in India.
For the purpose of their study, they compared ARBs (angiotensin-receptor blockers) combinations to ACEI based combinations in patients with hypertension
The study was a cross-sectional, observational study conducted at a Tertiary Care Medical University, Lucknow, from January 2017 to December 2018. 240 patients were screened out of which 199 patients on stable antihypertensives for over six weeks or who were previously or recently treated with antihypertensive medications were included in the study.
Target BP control was defined as brachial Systolic BP < 140 mmHg or Diastolic BP < 90 mmHg. Patients with liver dysfunction, signs and symptoms of heart failure, chronic kidney disease (CKD), or systemic inflammation and infection were excluded from the study. Hemodynamic factors like systolic pressure amplification phenomenon were used to measure peripheral BP, central BP, advanced hemodynamic indices, arterial stiffness, and vascular age. Other factors like the peripheral and central systolic BP (SBP) and diastolic BP (DBP), pulse pressure (PP), mean arterial pressure (MAP), PP amplification (PPA), age of vessels, peripheral resistance (PR), cardiac output (CO), stroke volume (SV), cardiac index (CI), augmentation pressure (AP), augmentation index (AI), reflection coefficient (RC), and pulse wave velocity (PWV) were compared in patients receiving different antihypertensive drug combinations and for this purpose the noninvasive Agedio B900 device (IEM, Stolberg, Germany) was used. Descriptive statistics were performed on all
All the 199 patients were on antihypertensive medication; 5.2% were on angiotensin II receptor blocker (ARB) and diuretics (ARB+diuretics), 32.7% were on ARB and CCB (ARB+CCB), 13.6% were on angiotensin-converting enzyme inhibitor (ACEI) and diuretics (ACEI+diuretics), and 6.5% were on ACEI and CCB (ACEI+CCB), while 2% were on other drugs. Subgroup analyses revealed that a total of 22 patients were on the long-acting ACEI, perindopril.
Key findings of the study revealed:
- Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively.
- The mean peripheral and central SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were significantly lower than those in patients treated with ARB-based combinations
- The mean peripheral SBP was the lowest in patients receiving ACEI+CCB (134:31 ± 11:35 mmHg), followed by those in the ACEI +diuretics (134:93 ± 21:96 mmHg) and ARB+diuretics (141:69 ± 18:49 mmHg), ARB+CCB (143:72 ± 18:62 mmHg)
- The mean central SBP in the ACEI+CCB group (119.92±10.39 mmHg) was significantly lower than that in the ARB+CCB group (132.69±18.26 mmHg); central SBP in others was comparable.
- Arterial stiffness was lowest in patients receiving ACEI+Diuretics (7.11± 04.67 mmHg) compared to other combinations -- 11.97±09.71 mmHg in the ARB+CCB group. It was comparable between other treatment groups.
- The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments.
- The mean vascular age was the lowest in the patients in the ACEI +diuretics treatment group (53:30 ± 13:38 years)
- In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments.
Thus, the authors concluded that most central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs.
Explaining the findings, the authors noted "the majority of our patients were treated by ARB-based combination of antihypertensives. Despite this, the most central hemodynamic parameters including vascular age were better in patients treated with ACEI than in those treated with ARB. Our study also suggests the use of CABP in routine practice to achieve the optimal management of hypertension."
They further added that the results from their study indicated a gap between routine clinical practice and evidence-based guidelines in Indian settings and identified a need to re-evaluate the current antihypertensive prescription strategy. They also suggested the use of CABP in routine practice to achieve the optimal management of hypertension.