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Combined antihypertensive drugs and antihypertensive/ statin combination seem to be superior in reducing blood pressure and inflammation

Background and Aims: Hypertension and inflammation facilitate the progression of nephropathy, particularly when albuminuria is present. The aim of the study was to compare the effect of renin-angiotensin system (RAS) inhibitors and statins alone and in combination on blood pressure, albuminuria, and C-reactive protein (CRP) and fibrinogen (FIB) as pro-inflammatory markers. Materials and Methods: A total of 328 hypertensive type 2 diabetics (56.48T10.9 yrs. old ; diabetes duration 11.2T6.7 yrs.) were studied over a 1-yr follow-up period. Patients were randomized to receive either angiotensinconverting enzyme (ACE) inhibitor lisinopril (group I, n=65), angiotensin receptor blocker (ARB) losartan (group II, n=52) and atorvastatin (group III, n=64), or lisinopril/ losartan (group IV, n=45) and atorvastatin/lisinopril combination (group V, n=58). The control group included 44 patients. CRP, FIB, atherogenic index of plasma (AIP), systolic (SBP), diastolic (DBP) and pulse pressure (PP) and albumin excretion rate (AER) were determined at the beginning and at the end of the study. The patients were assigned to groups based on AER/mg/24 h/(<15, 15&#8211; 30, 30&#8211; 300, >300) and PP (<45, 45&#8211; 50, 50&#8211; 65, >65). Wilcoxon signed ranks test and Kruskall-Wallis test were used in the statistical analysis. Results: Initial SBP, DBP, PP and AER were significantly reduced in the groups treated with RAS-inhibitors (generally p<0.01), but PP also fell in the group treated with atorvastatin (p=0.009). CRP decreased significantly in all groups (p<0.01), with the exception of Group II (p=0.232), whereas FIB was significantly reduced in the groups I, III and V (p=0.040, p=0.001 and p=0.023, respectively). AIP was significantly reduced in the atorvastatin-treated group (p<0.001). Among-group comparison revealed that the reduction in PP and SBP was most pronounced in Group IV (both p<0.001), while a difference in DBP reduction was not observed (p=0.147). Group III, followed by Group I, was the most effective in AER reduction. Group I and III did not differ in their effect on CRP and FIB (p=0.134 and p=0.256, respectively), whereas the reduction of CRP and FIB was more pronounced in Groups III and V, mainly in the group treated with the atorvastatin/lisinopril combination (p<0.01). Significant differences were found in initial CRP, FIB and AIP (p=0.01, p=0.004 and p=0.041, respectively) according to AER, and in FIB and AIP (both p<0.001) according to PP. Conclusion: Blood pressure, AER, AIP and inflammatory markers are among risk factors for the development of nephropathy. ACE-inhibitor/ARB and ACE-inhibitor/atorvastatin combinations seem to be more efficient than these drugs used separately in the reduction of BP and AER, and inflammatory markers, respectively.

blood pressure; inflamatory markers; nephropathy

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