We compared the influence of fixed dose combination valsartan160mg+hydrochlorthiazide
(HCTZ)25mg (n=33) and bisoprolol10mg+HCTZ25mg (n=27) on office, 24-hour and central blood pressure (BP); arterial stiffness and man sexual function.
There were included 60 patients with mean systolic BP (SBP)/diastolicBP(DBP)-167,3+/-0,8/90,3+/-0,9mmHg. Baseline and during treatment there were done office BP and heart rate measurements, ambulatory blood pressure monitoring, pulse wave velocity (PWV) measurement, central SBP and pulse BP measurements, biochemical blood analysis, ECG. In men the sexual dysfunction was evaluated by international index of erectile function multidimensional scale. Patients were randomized on combinations and if target BP was not achieved at 1 month the amlodipine (up-titrated to 10mg) and after 3 month doxasosine were added. Follow-up period was 6 months.
Both combination therapies were effective in office BP lowering (target BP - 100 and 96,3% in valsartan and bisoprolol groups respectively, NS), but in bisoprolol group there were used
higher doses of amlodipine (59,3vs27,3%) and more frequently doxazozine
(11,1vs0%) than in valsartan group. There were not noted any big differences in
decreasing of 24-hBP between groups, but night pulse BP and day-time variability of DBP lowered only in valsartan group. Both drug strategies were effective in diminishing of central SBP (lowering- -11,4+/-1,1vs -14,1+/-1,3mmHg on valsartan and bisoprolol respectively,NS), central SBP normalization rate was higher on valsartan (90,6%vs63%,P<0,02). Central pulse BP decreased significantly only in valsartan group (from 49,1+/-3,5 to 35,5+/-2,8mmHg, Р<0,01). In spite of significant decreasing of
central SBP, we noted significant increasing of augmentation index on bisoprolol from 32,2+/-1,3till36,7+/-1,3 %(Р<0,05), which was explained by heart rate diminishing. On valsartan augmentation index did not change significantly (27,2+/-5,2to19,4+/-1,98%). Significant decreasing of PWV we found only on valsartan. Both combination treatments were metabolic neutral and safe, but adverse reaction rate was higher for bisoprolol
44,4vs18,2%,P<0,05. Valsartan base therapy improved erectile function and total satisfaction in 23,8% men, while bisoprolol base therapy did not change any sexual function parameters.
Therapy based on valsartan+HCTZ combination might be more preferable, than on bisoprolol+HCTZ combination, especial in patients with higher arterial stiffness and in men
with sexual dysfunction.
