ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2018, 3(2): 71–77
https://doi.org/10.26693/jmbs03.02.071
Clinical Medicine

Influence of Reninangiotensin System Blockers on the Course of Hypertensive Disease with Type 2 Diabetes and Levels of Apelin and Angiotensin 1-7

Koval S., Yushko K., Starchenko T., Miloslavsky D., Penkova M.
Abstract

Both apelin and angiotensin 1-7 are functional antagonists of angiotensin II and have hypotensive, cardioprotective, antiatherosclerotic and antidiabetic properties, but the influence of different classes of the reninangiotensin system blockers on their metabolism was not conducted yet. The purpose of the study was to investigate the effects of combined treatment with olmesartan or ramipril on the background of providing lercanidipine and lipid-lowering and antidiabetic therapy on the course of hypertensive disease (HD) with type 2 diabetes (T2D) and blood levels of apelin and angiotensin 1-7. Material and methods. The study involved 70 patients with HD of 2-3 degrees with concomitant T2D (34 men and 36 women) aged from 40 to 70. The patients were examined before and after 12 month combined treatment with angiotensin receptor blocker olmesartan or angiotensin-converting enzyme inhibitor ramipril on the background of administering calcium antagonist lercanidipine and lipid-lowering therapy with atorvastatin and antidiabetic therapy with metformin. The investigation complex included clinical, laboratory and instrumental methods with determination of carbohydrate and lipid metabolism parameters, the blood levels of apelin and angiotensin 1-7, structural parameters of the heart left ventricular. The levels of apelin and angiotensin 1-7 were determined using ELISA. Results and discussion. Both variants of combined treatment caused comparable hypotensive, hypolipidemic and antidiabetic effects, improved left ventricular remodeling. The levels of apelin were significantly increased from 0,871(0,84;0,924) ng/ml before treatment to 0,976 (0,904;1,083) ng/ml (р<0,01) after treatment with olmesartan and from 0,875 (0,788;0,931) ng/ml to 0,940 (0,866;1,058) ng/ml (р<0,01) after treatment with ramipril. The levels of angiotesin 1-7 were significantly increased in patients who received olmesartan – from 108,39(92,32;121,17) ng/l to 130,43(124,42;138,37) ng/l (р<0,01) and did not change with ramipril – 104,37(87,16;122,83) ng/l versus 112,09(104,3;115,33) ng/l (p>0,05) respectively. In patients with basal levels of angiotesin 1-7 less median, the use of olmesartan, in contrast to ramipril, caused a significant decrease in the left ventricular myocardial mass index from 140,29±24,88 g/m2 to 130,81±19,96 g/m2 (р<0,01). Conclusions. Combined treatment with olmesartan or ramipril on the background of administering lercanidipine and lipid-lowering and antidiabetic therapy is comparatively effective in patients with HD and T2D. Among patients with severe angiotensin-1-7 deficiency, the use of olmesartan is more reasonable.

Keywords: hypertension, type 2 diabetes, reninangiotensin system, apelin, angiotensin 1-7

Full text: PDF (Ukr) 291K

References
  1. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31 (7): 1281-357. https://www.ncbi.nlm.nih.gov/pubmed/23817082. https://doi.org/10.1097/01.hjh.0000431740.32696.cc
  2. Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Diab Vasc Dis Res. 2014; 11 (3): 133-73. https://www.ncbi.nlm.nih.gov/pubmed/24800783. https://doi.org/10.1177/1479164114525548
  3. Kovalenko VN, Talaeva TV, Bratus' VV. Serdechno-sosudistye zabolevanija i renin-angiotezinovaja sistema. Kiev: Morion, 2013. 232 s. [Russian]
  4. Santos R.A. Angiotensin-(1-7). Hypertension. 2014; 63 (6): 1138-47. https://doi.org/10.1161/HYPERTENSIONAHA.113.01274
  5. Koval S, Yushko K, Starchenko T. Patogenetichne znachennja apelіnu v rozvitku gіpertenzії. Arterial'naja gipertenzija. 2016; 2 (46): 37-42. [Ukrainian]
  6. Zhang X, Zhang H, Ma Y, Che W, Hamblin MR. Management of Hypertension Using Olmesartan Alone or in Combination. Cardiol Ther. 2017; 6 (1): 13-32. https://www.ncbi.nlm.nih.gov/pubmed/28258390. https://www.ncbi.nlm.nih.gov/pmc/articles/5446820. https://doi.org/10.1007/s40119-017-0087-5
  7. Sіrenko JuM, Rekovec' OL. Ramipril u pacientov s arterial'noj gipertenziej v kachestve monoterapii ili v kombinacii s gidrohlortiazidom. Arterial'naja gipertenzija. 2017; 1: 81-91. [Ukrainian]
  8. Kadoglou NP, Sailer N, Kapelouzou A, Lampropoulos S, Vitta I, Kostakis A, Liapis CD. Effects of atorvastatin on apelin, visfatin (nampt), ghrelin and early carotid atherosclerosis in patients with type 2 diabetes. Acta Diabetologica. 2012; 49 (I.4): 269-76. https://www.ncbi.nlm.nih.gov/pubmed/21748474. https://doi.org/10.1007/s00592-011-0310-0
  9. Baysal SS, Pirat B, Okyay K, Bal UA, Uluçam MZ, Öztuna D, Müderrisoğlu H. Treatment-associated change in apelin concentration in patients with hypertension and its relationship with left ventricular diastolic function. Anatol J Cardiol. 2017; 17 (2): 125-31. https://www.ncbi.nlm.nih.gov/pubmed/27599667. https://www.ncbi.nlm.nih.gov/pmc/articles/5336750. https://doi.org/10.14744/AnatolJCardiol.2016.7035
  10. Fan Y, Zhang Y, Li X, Hui Z, Yuping S, Ning Z, Chunfang S, Xiaofang F, et al. Treatment with metformin and a dipeptidyl peptidase-4 inhibitor elevates apelin levels in patients with type 2 diabetes mellitus. Drug Des Devel Ther. 2015; 149: 4679-83. https://www.ncbi.nlm.nih.gov/pubmed/26316706. https://www.ncbi.nlm.nih.gov/pmc/articles/4544807. https://doi.org/10.2147/DDDT.S85740
  11. Wu H, Cheng XW, Hao C, Zhi Zh, Huali Ya, Murohara T, Dai H. Regulation of apelin and its receptor expression in adipose tissues of obesity rats with hypertension and cultured 3T3-L1 adipocytes. Exp Anim. 2014; 63 (2): 257-67. https://www.ncbi.nlm.nih.gov/pmc/articles/4160987. https://doi.org/10.1538/expanim.63.257
  12. Shimoura H, Tanaka H, Matsumoto K, Mochizuki Y, Hatani Y, Hatazawa K, Matsuzoe H, Ooka J, et al. Effects of a changeover from other angiotensin II receptor blockers to olmesartan on left ventricular hypertrophy in heart failure patients. Heart Vessels. 2017; 32 (5): 584-90. https://www.ncbi.nlm.nih.gov/pubmed/27722772. https://doi.org/10.1007/s00380-016-0904-0
  13. Fagard RH, Celis H, Thijs L, Wouters S. Regression of left ventricular mass by antihypertensive treatment: a meta-analysis of randomized comparative studies. Hypertension. 2009; 54: 1084–91. https://www.ncbi.nlm.nih.gov/pubmed/19770405. https://doi.org/10.1161/HYPERTENSIONAHA.109.136655