Influence of Long-Term Antihypertensive Therapy on Parameters of Central Aortal Pressure and Visceral Obesity in Patients with Arterial Hypertension and Diabetes Mellitus Type 2

Aim. To study the effect of long-term combined antihypertensive therapy with lisinopril plus amlodipine on the parameters of central aortic pressure (CAD) and visceral obesity in patients with arterial hypertension (HT) combined with type 2 diabetes mellitus (DM). Material and methods. 30 patients with stage III of HT and DM type 2 aged 40-65 years were included into the study. After "washout period", combined therapy with amlodipine 6.2 +/- 2.5 mg/day and lisinopril 12.3 +/- 5.0 mg/day was prescribed, hypolipidemic therapy with atorvastatin 17.0 +/- 4.7 mg/day and combined hypoglycemic therapy with metformin 1093.8 +/- 253.6 mg/day and gliclazide 82.1 +/- 38.5 mg/day were continued within 24 weeks. Initially, and after 24 weeks, a standard physical examination, 24-hour CAP parameters monitoring, body composition analysis with a percentage of visceral fat calculation, a visceral fat index (VAI) determination, the degree of adipose tissue dysfunction and the level of glycated hemoglobin (Hb(A1c)) assessment were performed. Results. Because of long-term therapy with lisinopril + amlodipine, a significant decrease in the level of office systolic (SBP) and diastolic blood pressure (DBP) by 22.3 and 12.5%, respectively, heart rate by 9,8%, and Hb(A1C) level by 1.4% was found in comparison with the initial values. According to bioimpedanceometry a statistically significant decrease in the percentage of visceral fat (by 13.6%) was revealed, as well as VAI (by 22.5%) and the percentage of patients with very high visceral fat (Delta%=-36.7, p<0.05). Indicators of central hemodynamics were significantly improved in the form of decrease in the average daily, daytime and nighttime values of aortic SBP, DBP, pulse blood pressure, and augmentation index. Conclusions. Thus, long-term combined therapy with lisinopril and amlodipine has shown not only high antihypertensive efficacy and the ability to reliably improve the parameters of CAD, but also to reduce the activity of visceral obesity, providing an additional positive metabolic effect without adjusting the dose of statins and hypoglycemic drugs.