Microcirculatory Effects of Antihypertensive Therapy in Patients with Hypertension

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Abstract

BACKGROUND: Growing interest in microcirculatory disorders among cardiology patients is due to the crucial role of the microcirculatory system in disease pathogenesis and by the fact that it is a target for pharmacological agents from various classes.

AIM: The study aimed to evaluate the microcirculatory effects of antihypertensive therapy over a 6-month period in patients with hypertension.

METHODS: Overall, 277 patients (209 women and 68 men) diagnosed with stage 2 hypertension, grade 1–2, risk categories 2 and 3, were examined. Their mean age was 58.7 ± 6.3 years, with an average disease duration of 11.2 ± 1.6 years (group 1). The control group (group 2) included 56 healthy individuals with a mean age of 54.1 ± 6.4 years. The women were postmenopausal without clinical symptoms. Group 1 received either combined therapy with indapamide and lisinopril or monotherapy with nebivolol, indapamide, losartan, or lisinopril, as prescribed in outpatient care. Terminal blood flow was assessed at baseline and after 1, 3, and 6 months using laser Doppler flowmetry following standard protocols.

RESULTS AND DISCUSSION: After 6 months of antihypertensive treatment and reaching target blood pressure levels, a shift in microcirculation types was observed, with a decrease in the number of pathological ones. Microcirculatory parameters under monotherapy did not fully normalize peripheral perfusion and remained below the levels observed in the healthy control group. The closest values were noted in patients receiving unfixed combination of lisinopril and indapamide with normocirculatory microcirculation.

CONCLUSION: Analysis of the microcirculatory effects of prescribed therapy in patients with stage 2, grade 1–2 hypertension, risk categories 2–3, revealed variable responses at the microvascular level. This indicates that combination therapy with lisinopril and indapamide is a more rational approach.

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About the authors

Natalia A. Samorodskaya

Kuban State Medical University

Author for correspondence.
Email: samnatdoc@mail.ru
ORCID iD: 0000-0002-9723-1176
SPIN-code: 4021-9600

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Krasnodar

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2. Fig. 1. Dynamics of microcirculatory indices against the background of lisinopril monotherapy in group 1 patients with regard to microcirculatory type: StST - stasis type; SPT - spastic type; NCT - normocirculatory type; PM - microcirculatory index; RMS - standard deviation; KV - coefficient of variation; VA - vasomotor activity; IVR - autonomic regulation index (and further in the figures).

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3. Fig. 2. Dynamics of microcirculation parameters against the background of indapamide monotherapy in group 1 patients with regard to microcirculatory type.

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4. Fig. 3. Dynamics of microcirculation parameters against the background of lisinopril and indapamide combination therapy in group 1 patients with regard to microcirculatory type.

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