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

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.