2013


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2013/№1

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.
  1. Мухарлямов Н. М., Мареев В. Ю. Лечение хронической сердечной недостаточности. –М.: Медицина. –1985. –208 с.
  2. Owan TE, Hodge DO, Herges RM et al. Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2006;355 (3):251–259.
  3. Lenzen MJ, Scholte op Reimer WJ, Boersma E et al. Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey. Eur Heart J. 2004;25 (14):1214–1220.
  4. Беленков Ю. Н., Фомин И. В., Мареев В. Ю. и др. Первые результаты Российского эпидемиологического исследования по ХСН. Журнал Сердечная Недостаточность. 2003;4 (1):26–30.
  5. Мареев В. Ю., Даниелян М. О., Беленков Ю. Н. От имени рабочей группы исследования ЭПОХА–О–ХСН. Сравнительная характеристика больных с ХСН в зависимости от величины ФВ по результатам Российского многоцентрового исследования ЭПОХА–О–ХСН. Журнал Сердечная Недостаточность. 2006;7 (4):164–171.
  6. Fonarow GC, Stough WG, Abraham WT et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50 (8):768–777.
  7. Levy D, Larson M, Vasan R et al. The progression from hypertension to congestive heart failure. JAMA. 1996;275 (20):1557–1562.
  8. Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol. 1995;26 (7):1565–1574.
  9. Беленков Ю. Н., Агеев Ф. Т., Мареев В. Ю. Знакомьтесь: Диастолическая сердечная недостаточность. Журнал Сердечная недостаточность. 2000;1 (2):40–44.
  10. Zile MR. Heart failure with preserved ejection fraction: Is this diastolic heart failure? J Am Coll Cardiol. 2003;41 (9):1519–1522.
  11. Агеев Ф. Т. Диастолическая сердечная недостаточность: 10 лет знакомства. Журнал Сердечная недостаточность. 2010;11 (1):69–76.
  12. Holland DJ, Kumbhani DJ, Ahmed SH, Marwick TH. Effects of treatment on exercise tolerance, cardiac function, and mortality in heart failure with preserved ejection fraction. A meta-analysis. J Am Coll Cardiol. 2011;57 (16):1676–1686.
  13. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Журнал Сердечная Недостаточность. 2010;11 (1):3–62.
  14. Dickstein K, Cohen-Solal A, Filippatos G et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29 (19):2388–2442.
  15. Philbin EF, Rocco TA Jr, Lindenmuth NW et al. Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors. Am J Med. 2000;109 (8):605–613.
  16. Miyagishima K, Hiramitsu S, Kimura H et al. Long term prognosis of chronic heart failure: reduced vs preserved left ventricular ejection fraction. Circ J. 2009;73 (1):92–99.
  17. Осмоловская Ю. Ф., Мареев В. Ю., Глечян А. М. и др. Артери­аль­ная жесткость и показатели эндотелиальной дисфункции микроциркуляторного русла у пациентов ХСН с сохранной и сниженной сократительной функцией миокарда левого желудочка. Журнал Сердечная Недостаточность. 2011;12 (3):142–148.
  18. Mottram PM, Haluska BA, Leano R et al. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart. 2005;91 (12):1551–1556.
  19. Agoston-Coldea L, Mocan T, Bobar C. Arterial stiffness and left ventricular diastolic function in the patients with hypertension. Rom J Intern Med. 2008;46 (4):313–321.
  20. Elesber AA, Redfield MM, Rihal CS et al. Coronary endothelial dysfunction and hyperlipidemia are independently associated with diastolic dysfunction in humans. Am Heart J. 2007;153 (6):1081–1087.
  21. Ma LN, Zhao SP, Gao M et al. Endothelial dysfunction associated with left ventricular diastolic dysfunction in patients with coronary heart disease. Int J Cardiol. 2000;72 (3):275–279.
  22. Cleland JG, Tendera M, Adamus J et al. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27 (19):2338–2345.
  23. Yip GW, Wang M, Wang T et al. The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction. Heart. 2008;94 (5):573–580.
  24. Aronow W, Kronzon I. Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction. Am J Cardiol. 1993;71 (7):602–604.
  25. Мареев В. Ю., Овчинников А. Г., Агеев Ф. Т., Беленков Ю. Н. Влияние ингибиторов АПФ и антагонистов рецепторов к ангиотензину-II на диастолическую функцию левого желудочка у пациентов с относительно сохранной систолической функцией левого желудочка: результаты исследования «Периндоприл, ИРбесартан и АмлодипиН у болЬных с ХСН и сохраненной систолической функцией левого желудочка (ПИРАНЬя). Журнал Сердечная Недостаточность. 2005;6 (1):4–14.
  26. Ferrari R. Effects of angiotensin – converting enzyme inhibition with perindopril on left ventricular remodeling and clinical outcome: results of the randomized Perindopril and Remodeling in Elderly with Acute Myocardial Infarction (PREAMI) Study. Arch Intern Med. 2006;166 (6):659–666.
  27. Harrison DG. Cellular and molecular mechanisms of endothelial cell dysfunction. J Clin Invest. 1997;100 (9):2153–2157.
  28. Ferrari R, Fox KM. The mode of action of perindopril. In: Perindopril: a major contribution to the prevention and treatment of cardiovascular disease. Edited by Ferrari F.& Fox KM. – Wolters Kluwer, 2008. – p.4–13.
  29. Katz SD, Biasucci L, Sabba C et al. Impaired endothelium-media­ted vasodilation in the peripheral vasculature of patients with congestive heart failure. J Am Coll Cardiol. 1992;19 (5):918–925.
  30. Borlaug BA, Olson TP, Lam CS et al. Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2010;56 (11):845–854.
  31. Austin BA, Popovic ZB, Kwon DH et al. Aortic stiffness independently predicts exercise capacity in hypertrophic cardiomyopathy: a multimodality imaging study. Heart. 2010;96 (16):1303–1310
  32. Laurent S, Cockcroft J, Van Bortel L et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27 (21):2588–2605.
  33. Mallareddy M, Parikh CR, Peixoto AJ. Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2006;8 (6):398–403.
  34. Агеев Ф. Т., Овчинникова А. Г., Мареев В. Ю. Эндотелиальная дисфункция и сердечная недостаточность: патогенетическая связь и возможности терапии иАПФ. Consilium Medicum. 2001;3 (2):61–65.
  35. Hornig B, Kohler C, Drexler H. Role of bradykinin in media­ting vascular effects of angiotensin-converting enzyme inhibitors in humans. Circulation. 1997;95 (5):1115–1118.
  36. Bots ML, Remme WJ, Luscher TF et al. ACE inhibition and endothelial function: main findings of PERFECT, a sub-study of the EUROPA trial. Cardiovasc Drugs Ther. 2007;21 (4):269–279.
  37. Ceconi C, Fox KM, Remme WJ et al. ACE inhibition with perindopril and endothelial function. Results of substudy of the EUROPA study: PERTINENT. Cardiovasc Res. 2007;73 (1):237–246.
  38. Asmar R, Topouchian J, Pannier B et al. Pulse wave velocity as endpoint in large-scale intervention trial. The Complior study. Scientific, Quality Control, Coordination and Investigation Committees of the Complior Study. J Hypertens. 2001;19 (4):813–818.
  39. Zhuo JL, Froomes P, Casley D et al. Perindopril chronically inhi­bits angiotensin-converting enzyme in both the endothelium and adventitia of the internal mammary artery in patients with ischemic heart disease. Circulation. 1997;96 (1):174–182.
  40. Zhuo JL, Mendelsohn FA, Ohishi M. Perindopril alters vascular angiotensin-converting enzyme, AT (1) receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension. 2002;39 (2 Pt 2):634–638.
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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