Optimization of Blood Pressure Control, Metabolic Parameters, and Target Organs Protection with Perindopril + Indapamide Fixed Combination in Hypertensive Patients with Obesity and Prediabetes

The study objective was to evaluate the ability of the fixed combination (FC) of perindopril + indapamide (P+I) to reduce insulin resistance and low intensive noninfectious inflammation as well as to improve arterial elasticity in patients with hypertension, obesity and prediabetes on previous successful antihypertensive therapy with losartan + hydrochlorothiazide (L+HTZ) 100/12.5 mg. A 12-week open-label study included 50 patients (age 54.8 ± 6.6 years, body mass index (BMI) 32.5 ± 3.2 kg/m2). All patients underwent a 24-hour ambulatory blood pressure monitoring, applanation tonometry (assessment of augmentation index (AI), central blood pressure (CBP)), pulse wave velocity (PWV) measurement and laboratory investigations (lipid profile, fasting glucose, the homeostatic model assessment (HOMA) index, homocysteine, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP)). Results: The switch of patients from L+HTZ to a FC of P+I resulted in an additional decrease in systolic BP and diastolic BP by 3.9% and 5.4%, respectively (p <0.05). Significant decrease in the BP load and variability was observed. PWV, AI, central SBP, vascular age decreased by 2.2%, 9.4%, 2.1% and 6.0% (p <0.05 for all). Fasting glycemia, insulinemia, and HOMA index decreased by 4.9%, 6.0% and 10.3% (p <0.05 for all). Triglycerides (TG) decreased by 13.5% (p<0.05) and high density lipoproteins (HDL) increased by 9.6% (p <0.05). Leptin and hsCRP levels decreased by 14.4% and 11.0%, adiponectin increased by 9.9% (p <0.05 for all). Clinically significant results were obtained in weight and BMI reduction on 6,0% and 1,2%. Conclusions: FC of P+I is superior to the L+HTZ in BP control, improvement of arterial elasticity and promotes a decrease in BMI, suppression of insulin-resistance and low intensive noninfectious inflammation in patients with hypertension, associated obesity and prediabetes. Disclosure S.V. Nedogoda: None. I. Barykina: None. A. Salasyuk: None. V.O. Smirnova: None. E. Popova: None.