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Internal and Emergency Medicine
Published in: Internal and Emergency Medicine 7/2017

01-10-2017 | IM - ORIGINAL

Comparison of lercanidipine plus hydrochlorothiazide vs. lercanidipine plus enalapril on micro and macrocirculation in patients with mild essential hypertension

Authors: Carolina De Ciuceis, Massimo Salvetti, Anna Paini, Claudia Rossini, Maria Lorenza Muiesan, Sarah Duse, Stefano Caletti, Maria Antonietta Coschignano, Francesco Semeraro, Valentina Trapletti, Fabio Bertacchini, Valeria Brami, Alina Petelca, Enrico Agabiti Rosei, Damiano Rizzoni, Claudia Agabiti Rosei

Published in: Internal and Emergency Medicine | Issue 7/2017

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Abstract

Dihydropyridine calcium channel blockers may possess antioxidant properties, and might improve micro and macrovascular structure and function. Combination treatment with an ACE inhibitor may have additional advantages, compared with a thiazide diuretic. The aim of the present study is to investigate the effects of a short-term treatment with lercanidipine, and to compare two combination treatments: lercanidipine + enalapril vs. lercanidipine + hydrochlorothiazide on structural alterations in retinal arterioles, on skin capillary density and on large artery distensibility. Thirty essential hypertension patients are included in the study, and treated for 4 weeks with lercanidipine 20 mg per day orally. Then, they were treated for 6 months with lercanidipine + enalapril (n = 15) or lercanidipine + hydrochlorothiazide (n = 15) combinations. Investigations were performed on basal condition, after appropriate wash out of previous treatments, after 4 weeks of lercanidipine monotherapy treatment, and at the end of the combination treatment. Non-invasive measurements of wall-to-lumen ratio (WLR) and other morphological parameters of retinal arterioles were performed using either scanning laser Doppler flowmetry or adaptive optics. Capillary density was evaluated by capillaroscopy, while pulse wave velocity was measured, and central blood pressures were assessed by pressure waveform analysis. A significant improvement of WLR and other indices of retinal artery structure is observed with both technical approaches after treatment with lercanidipine alone, with a further improvement after treatment with lercanidipine + enalapril, while after treatment with lercanidipine + hydrochlorothiazide, the improvement is partially blunted. Central systolic and diastolic blood pressures are similarly reduced by both therapeutic strategies. Capillary density is increased only after treatment with lercanidipine + enalapril. In conclusion, lercanidipine both in monotherapy and in combination with enalapril but not with hydrochlorothiazide is able to improve microvascular structure; on the other hand, a decrease in central blood pressure is observed with both therapeutic combinations.
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Metadata
Title
Comparison of lercanidipine plus hydrochlorothiazide vs. lercanidipine plus enalapril on micro and macrocirculation in patients with mild essential hypertension
Authors
Carolina De Ciuceis
Massimo Salvetti
Anna Paini
Claudia Rossini
Maria Lorenza Muiesan
Sarah Duse
Stefano Caletti
Maria Antonietta Coschignano
Francesco Semeraro
Valentina Trapletti
Fabio Bertacchini
Valeria Brami
Alina Petelca
Enrico Agabiti Rosei
Damiano Rizzoni
Claudia Agabiti Rosei
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
Internal and Emergency Medicine / Issue 7/2017
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-017-1696-7

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