Arterial hypertension is an important risk factor for cardiovascular disease-related morbidity and mortality. Aldosterone is now consider a major cardiovascular risk hormone. Treatment strategies based on association angiotensin II receptor blockers (ARBs) and canrenone (Cr) in hypertensive patients could give benefits aldosterone-induced detrimental effects like increase of superoxide radicals, endothelial dysfunction, collagen deposition, arterial stiffness and cardiac remodeling.Design and method:
This retrospective cross-sectional study aimed to compare the effect of ARBs, ARBs+Cr and ARBs+hydrochlorothiazide (Hct) therapy on central haemodynamic parameters (CHPs) in hypertensive patients with normal kidney function. The most frequently administered ARBs were candesartan, irbesartan and valsartan (80%). The average dose used in both genders of Cr and Hct was 37 and 15 mg, respectively. Were measured CHPs in the supine position after at least 10 minutes of rest, by the SphygmoCor System (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry. Was assessed the difference between the observed values and the expected values of AIx (Diff-AIx) according to normal ranges by age.Results:
Data were collected from 809 hypertensive patients (60% females). CHPs were analyzed by gender and therapy subgroups. Results show that the combination of ARBs+Cr (female/male 211/125) provided the lowest CHP values, compared to ARBs alone (female/male 150/116) and ARBs+Hct (female/male 122/85), this was true for each parameter considered. The difference among treatment groups was statistically significant for all CHPs except for Pulse-Pressure and Augmentation-Pressure between male patients receiving ARBs and ARBs+Hct. Particularly, ARBs+Cr therapy but not ARBs alone or with Hct lowered AIx below the reference value in both male (Diff-AIx: -1.0, +0.8 and +2, respectively) and female patients (Diff-AIx: -2.1, 0 and +2.3, respectively). Interestingly, the value of the End-Systolic-Pressure (mmHg) in the ARBs+Cr group (female/male 101/100.4) was lower than ARBs alone (female/male 108.2/104.5) and ARBs+Hct (female/male 114.7/111.6).Conclusions:
The findings suggest that ARBs+Cr treatment produces best haemodynamic conditions in hypertensive patients, it could be helpful to reduce or prevent the short- and long-term harmful effects of angiotensin-aldosterone system such as diastolic dysfunction, left ventricular post-load, and consequently the atrial fibrillation.