Background. Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods. This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results. A total of 199 patients with a mean age of years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure . Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age ( vs. , ). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (). A total of 6.5% patients experienced any side effects. Conclusion. The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.

中文翻译：

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肾素-血管紧张素-醛固酮系统抑制剂组合对中心主动脉血压的不同影响：高血压门诊患者的横断面观察研究

背景。与仅测量臂带压力相比，中心主动脉血压 (CABP) 指数、中心血流动力学和动脉硬度是心血管事件的更好预测指标。本研究旨在评估涉及肾素-血管紧张素-醛固酮系统 (RAAS) 抑制剂的不同抗高血压药物联合方案对印度高血压患者 CABP 指数的影响。方法. 这是一项横断面、单中心研究，在高血压患者中使用不同的治疗方案进行了超过 6 周的治疗，其中包括 RAAS 抑制剂与其他类别药物的组合。使用无创 Agedio B900 设备（IEM，Stolberg，德国）测量患者的 CABP 指数、血管年龄、动脉僵硬度和中心血流动力学，并在不同治疗方案之间进行比较。结果。共有 199 名患者，平均年龄为入组，其中 68.8% 患有高血压 3 年以上，50.25% 患有收缩压. 分别有 77.9% 和 20.1% 的患者接受了血管紧张素 II 受体阻滞剂 (ARB) 和血管紧张素转换酶抑制剂 (ACEI) 的联合治疗。平均血管年龄高于实际年龄（对比, ）。接受基于 ACEI 的联合治疗的患者的 SBP 和舒张压 (DBP) 水平低于接受基于 ARB 的联合治疗的患者。）。接受基于 ACEI 的组合治疗的患者的平均中心脉压放大、增强压力和增强指数低于接受其他治疗的患者。）。在亚组分析中，给予培哚普利和钙通道阻滞剂 (CCB) 或利尿剂的患者的 CABP 和脉搏波速度显着低于给予其他治疗的患者。）。共有 6.5% 的患者出现任何副作用。结论。发现接受 ACEI 治疗的患者比接受 ARB 治疗的患者的大多数中心血流动力学参数（包括血管年龄）更有效地改善。我们的结果表明印度环境中常规临床实践和循证指南之间存在差距，并确定需要重新评估当前的抗高血压处方策略。