Impact of long-term antihypertensive therapy on the vasoregulating function of the brachial artery in patients with arterialhypertension associated with type 2 diabetes mellitus


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Abstract

Aim. To evaluate the impact of 6-month-to-one-year antihypertensive therapy on the vasoregulating
function of the brachial artery and predictors of its efficiency in 75 patients with stages I-II arterial
hypertension associated with type 2 diabetes mellitus.
Materials and methods. An open randomized study of parallel groups of patients receiving angiotensin-converting enzyme (ACE) inhibitors, calcium blockers (verapamil) and their combination and
in those who did not take antihypertensive therapy examined endothelium-dependent vasodilation
(EDVD) according to the data of ultrasound scanning and Doppler study of brachial arterial blood
flow as compared with changes in metabolism and 24-hour blood pressure profile.
Results. A positive effect of verapamil on the baseline impaired EDVD is realized only in the presence
of an adequate compensation of glycemia, at the normal blood level of Cortisol, occurs in parallel with
increased nonendothelium-dependent vasoreactivity, and associates with the magnitude of an antihypertensive effect. ACE inhibitors improve decreased EDVD irrespective of the degree of glycemic control, the blood level of Cortisol without a clear correlation with the altered non-endothelium-dependent
vasoreactivity and with the degree of an antihypertensive effect. Combined therapy with these agents
causes decreases in baseline insulinemia and the athoregenicity index and it can improve impaired vasoreactivity even in case of incomplete antihypernsive therapeutic effect.
Conclusion. The differences found in the effect of ACE inhibitors and verapamil on baseline decreased
EDVD provide evidence for differential use of these drugs to correct impaired vasoreactivity in patients
with AH associated with DM. The combined antihypertensive therapy fails to produce a positive impact if significant hypercholesterolemia (total blood cholesterol being more than 6.5 mmol/l) and stenosing peripheral atherosclerosis are present.

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