Estudo da função vascular em hipertensos com diabetes tipo 2 em uso de losartana ou anlodipino

Abstract

Cardiovascular diseases are still the leading cause of death worldwide, and hypertension and diabetes are among its major risk factors. It is well known that hypertension and type 2 diabetes are often associated diseases. The choice of antihypertensive drugs to be used in the treatment of hypertensive patients with diabetes aims to control blood pressure, reducing morbidity and mortality from macrovascular and microvascular complications. Changes in endothelial function precede morphological vascular changes and contribute to the development of macrovascular complications. The aim of this study was to evaluate the association of vascular function with the use of losartan or amlodipine in hypertensive type 2 diabetics. A cross-sectional study was conducted with patients randomly divided into two groups, being evaluated in the sixth week of using losartan 100 mg / day or amlodipine 5 mg / day, with BP measurement, performance of ambulatory blood pressure monitoring and tests to evaluate vascular parameters such as applanation tonometry, pulse wave velocity (PWV) and flow-mediated dilatation (FMD) of the brachial artery. We included 42 patients, 21 in each group. The distribution of the sample showed a female predominance (71%) in both groups and a similarity in the average age (54.0 ± 6.9 years in the losartan group and 54.9 ± 4.5 years in group amlodipine). At 6 weeks of antihypertensive treatment, the mean blood pressure values were 153 ± 19/90 ± 9 mmHg in the losartan group and 145 ± 14/84 ± 8 mmHg in the amlodipine group, with no statistical difference between the groups. The augmentation index (AIx; 30 ± 9 vs. 8 ± 36%, p=0.025) as well as augmentation pressure (16 ± 6 vs. 8 ± 20 mmHg, p=0.045) in the amlodipine group was lower than in group losartan. The values obtained for PWV and FMD were similar in both groups. In hypertensive patients with type 2 diabetes, treatment with amlodipine on average dose compared to maximum dose of losartan was associated with lower levels of casual blood pressure. Lower values of AIx were observed in the amlodipine group, with a more favorable standard pulse wave reflection in this group. The similar values of PWV and FMD in the two groups may suggest influences of losartan on vascular parameters independent of the blood pressure effect.