Optimization of treatment of endothelial dysfunction and arterial stiffness in patients with arterial hypertension and ischemic heart disease
Authors: Khakuasheva I. A. , Umetov M. A. , Kuzhonova M. Zh. , Gataova I. M. , Abazova D. Z. 
Published: January 2025

The relevance of complex correction of endothelial dysfunction and arterial stiffness in patients with arterial hypertension and coronary heart disease is associated with their leading role in the development of cardiovascular diseases. Endothelial dysfunction, characterized by a deficiency of vasodilators, such as nitric oxide, and an increase in vasoconstrictor mediators, contributes to atherogenesis and thrombosis. At the same time, an increase in arterial stiffness leads to an increase in systolic pressure and impaired diastolic filling of the myocardium, which aggravates myocardial ischemia and contributes to the progression of heart failure. The introduction of an integrative approach to optimizing endothelial function and reducing arterial stiffness into clinical practice can significantly improve the prognosis and quality of life of patients, reducing the risk of serious cardiovascular events, including myocardial infarction and stroke. Results from randomized clinical trials support the efficacy of such a strategy, demonstrating that normalization of endothelial function and reduction in arterial stiffness are achievable with modern antihypertensive and lipidlowering drugs, including polypills. These drugs improve treatment adherence through simplified dosing regimens and provide effective management of multifactorial risks in patients. In addition, ongoing research and development of new therapeutics and treatments continue to highlight the need for early detection and targeted therapy in this patient population. Such strategies not only address the underlying pathophysiological changes but also aim to prevent long-term complications associated with these cardiovascular risk factors. By focusing on an individualized treatment protocol that includes both pharmacologic interventions and lifestyle changes, healthcare providers can offer a more dynamic and effective treatment plan that meets each patient’s individual needs, thereby optimizing therapeutic outcomes and improving patient compliance.Background. Cardiovascular diseases are the leading cause of death in Russia, with hypertension, coronary heart disease, and cerebrovascular disease predominating. The prevalence of hypertension is 53.9 %, but disease control remains poor, with less than 30 % of patients achieving target blood pressure levels. Therapy often includes combinations of medications, such as ACE inhibitors and angiotensin receptor blockers, which demonstrate advantages over monotherapy. Approximately 70.7 % of patients require combination therapy to effectively manage their condition.Objective. Comparison of the effects of fixed combinations of amlodipine, atorvastatin and perindopril (Lipertance® 10/20/10 mg) with a combination of amlodipine, lisinopril and rosuvastatin (Equamer® 5/10/20 mg) on the clinical progression of grade 2 and 3 arterial hypertension and functional class II and III coronary heart disease. Also study the effect on arterial stiffness, endothelial function, ankle-brachial index, vascular age.Materials and methods. The study included 65 patients with uncontrolled hypertension with systolic blood pressure (BP) ≥160 mmHg and/or diastolic BP ≥90 mmHg in combination with stable angina, taking two antihypertensive drugs at the beginning of the study. Depending on the therapy, the participants were divided into II groups: I – 30 people receiving a fixed combination of Lipertance; II group – 35 people taking a fixed combination of Equamer. All patients also received bisoprolol at a dosage of 5–10 mg and an antiplatelet agent at a dosage of 75–100 mg.Conclusions. Fixed combinations of Lipertance® and Equamer® drugs were highly effective in controlling blood pressure in patients with hypertension and coronary heart disease, achieving target systolic and diastolic levels in more than 85 % of patients. Both groups showed significant improvements in arterial stiffness and endothelial function, demonstrating their potential to reduce cardiovascular complications. Thus, these combinations can be recommended for routine use in clinical practice to improve prognosis and quality of life in patients.