Potentials for dual RAAS blockade in the correction of endothelial dysfunction in hypertensive patients: comparative study

Background. The efficacy and safety of mineralocorticoid receptor antagonists (MRA) in arterial hypertension (AH) remain debatable. The effect of the dual renin-angiotensin-aldosterone system (RAAS) blockade with the use of the angiotensin II receptor antagonist and MRA on endothelial function in hypertensive patients requires investigation. Objective: Evaluation of the effect of combination therapy with valsartan and spironolactone on endothelial function in hypertensive patients. Methods. Sixty patients with stage 2 arterial hypertension were divided into 2 groups: group 1 received valsartan, group 2 - valsartan in combination with spironolactone. As appropriate, hydrochlorothiazide and/or amlodipine were added to therapy. The follow-up duration was 12 months. Before and at the end of the study, all patients underwent 24-hour blood pressure (BP) monitoring and reactive hyperemia test. Results. Target blood pressure levels were achieved in all cases. The degree of BP reduction and favorable effects on its daily profile were more pronounced in the group 2 (p<0.05). In both groups, a significant improvement in vascular reactivity was observed: in the group 1, against the background of reactive hyperemia, there was an increase in the diameter of the brachial artery by 9.3±3.89%, in the group 2 - by 17.68±5.89% (p<0.05). Conclusion. Combined therapy with valsartan and spironolactone was well-tolerated and has demonstrated a significant antihypertensive effect. The use of valsartan in combination with spironolactone was associated with a more pronounced improvement in endothelial function, according to the reactive hyperemia test.

arterial hypertension, endothelial dysfunction, reactive hyperemia, spironolactone, valsartan