Comparação dos efeitos do benazepril e da losartana sobre a função endotelial e a rigidez arterial em pacientes diabéticos com hipertensão não controlada por anlodipino

Abstract

In hypertensive diabetic patients, the renin-angiotensin-aldosterone system is related to endothelial dysfunction, vascular stiffness and atherosclerosis. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are two of the most important medications that inhibit this system. Most international guidelines recommend them interchangeably, albeit small differences may have clinical relevance. The main objective was to compare inflammatory parameters (by C-reactive protein), endothelial function (by flow-mediated vasodilation) and vascular stiffness (by pulse wave velocity and aortic pressures) between benazepril and losartan in hypertensive diabetic patients whose blood pressure was not controlled by amlodipine. The secondary objective was a post-hoc analysis to study possible synergism between statins and renin-angiotensin-aldosterone system inhibitors. Blood pressure reduction, endothelial function and vascular stiffness were compared between patients using or not statins. Main results showed that C-reactive protein had lower values in benazepril group [0.38 (0.15-0.95) mg/dl vs 0.42 (0.26-0.59) mg/dl, p=0.020]. There was a slightly higher flow-mediated vasodilation response in benazepril group (45% of increase, p=0.057) than in losartan group (19% of increase, p=0.132). Aortic systolic blood pressure [129 (121-145) mmHg vs 123 (117-130) mmHg, p=0.934] and carotid-femoral pulse wave velocity [8.5 (7.8-9.4) m/s vs 8.5 (7.0-9.7) m/s, p=0.280] were the same between groups. Secondary results showed that patients using statins had greater reduction in mean systolic blood pressure in 24 hour monitoring [134 (120-146) mmHg to 122 (114-135) mmHg, p=0.007] than patients not using statins [137 (122-149) mmHg to 128 (122-140) mmHg, p=0.362]. Patients using statins had higher flow-mediated vasodilation response [6.5% (5.1-7.1) to 10.9% (7.3-12.2), p=0.003] than those not using statins [7.5% (6.0-10.2) to 8.3% (7.5-9.9), p=0.820]. There was no difference in pulse wave velocity nor in aortic pressure between patients using or not statins. Hypertensive diabetic patients in use of benazepril had a greater reduction in C-reactive protein and a slight improvement in flow-mediated vasodilation than those taking losartan. Moreover, combination of statin, anlodipine and renin-angiotensin-aldosterone system inhibitors promoted greater blood pressure reduction and amelioration of endothelial function in hypertensive diabetic patients