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Perindopril in comparison with other ACE inhibitors in treatment of hypertension, complicated with diastolic heart failure (PAGODA study)

Glechyan A. М., Osmolovskaya Yu. F., Satlykova D. F., Deev A. D., Ageev F. T., Seredenina E. М., Lopatin Yu. М., Davydova N. A., Ivanenko V. V., Kaplanov Т. D., Nedogoda С. V., Tsoma V. V., Lediaeva A. A., Chumachek E. V., Salasiuk A. S., Saidova M. A., Mareev V. Yu.

Keywords: hyperpiesis, vascular stiffness, ACE inhibitors, perindopril, CHF

DOI: 10.18087/rhfj.2013.1.1800

Relevance. Despite high prevalence of CHF with preserved LV systolic function (CHF–PSF), its treatment has not been quite developed from the evidence-based medicine standpoint. Objective. The objective of this study was to evaluate effect of ACE inhibitors on clinical status of patients with hypertension and CHF–PSF, assessment of their antihypertensive effect and influence on arterial stiffness and endothelial dysfunction. Materials and methods. The study was carried out with participation of 98 patients with hypertension degree I–II and CHF–PSF FC I–III. Group I (main) comprised 67 patients who took perindopril 8 mg / day, group II (control) – 31 patients who took any ACE inhibitors. Patient examination included patient clinical assessment by SHOKS, 6minute walk test, assessment of quality of life with use of MLHFQ questionnaire and depression and anxiety with use of HADS scale; EchoCG; 24hour BP monitoring; measurement of pulse wave velocity (PWV) and assessment of endothelial function. Results. During the observational period (6 months), statistically significant improvement of clinical and functional status of patients were detected in both groups, as well as better quality of life and CHF FC; reduction of hospitalization quantity, number of sick-leave days and emergency calls; better systolic and diastolic cardiac function; reduction of PWV and increase of flow-dependent vasodilatation, were more evident in the perindopril group. According to 24hour BP monitoring, significant BP reduction by all averaged indices was detected in both study groups. No statistically significant difference between the groups in 24hour BP monitoring index dynamics were detected. Conclusion. Perindopril therapy is treatment of choice for patients with CHF–PSF. Its advantages in left ventricular hypertrophy, improvement of diastolic LV filling and associated clinical presentations of the disease in the group of patients with CHF–PSF. With initiation of perindopril administration 8 mg / day, the overwhelming majority of patients effectively and safely continued treatment without dose correction.
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Glechyan A. М., Osmolovskaya Yu. F., Satlykova D. F. et al. Perindopril in comparison with other ACE inhibitors in treatment of hypertension, complicated with diastolic heart failure (PAGODA study). Russian Heart Failure Journal. 2013;14 (1):3-13

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