Arterial stiffness in patients with acute coronary syndrome without persistent ST segment elevation combined with chronic kidney disease and arterial hypertension and its correction with antihypertensive therapy

Objective: to study arterial stiffness in patients with acute coronary syndrome without ST elevation, who have hypertension (AH) and stage 2-3A chronic kidney disease (CKD) and to assess the ability of angiotensin-converting enzyme inhibitor perindopril and angiotensin receptor antagonist losartan to reduce arterial stiffness in these patients. Materials and Methods. We studied 44 patients with ACS without ST elevation combined with CKD stage 2-3A, AH (the 1st group). The comparison groups were the ACS without ST segment elevation, AH patients with normal renal function (the 2nd group, n=27) and the 3rd group (n=44) of patients with chronic CHD, AH and CKD. Group 1 patients were divided into 2 subgroups taking perindopril or losartan. The parameters of vascular wall stiffness (pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), ankle brachial index (ABI), aortic augmentation index (AI), central systolic and pulse aortic pressure, peripheral blood pressure (BP), estimated glomerular filtration rate (GFR) were assessed.) Results. The patients with ACS without ST elevation combined with 2-3A stages of CKD and AH had a significantly higher cPAP, AI, PWV, and CAVI than the patients of the 2nd group. During 3 months of complex therapy with perindopril, a decrease in PWV, cSAP, cPAP, AI was observed. There were no significant differences in the effects of perindopril and losartan on peripheral and central blood pressure, on renal function, on arterial stiffness parameters. Conclusion. Patients with AH and CKD stage 2-3A have more pronounced arterial stiffness compared to similar patients with normal GFR. Antihypertensive therapy with perindopril and losartan allows to reach target levels of peripheral BP, significantly reduce central aortic pressure and improve elastic properties of the arterial vascular wall.