Abstracts e173
Results: After measuring the body mass index, waist circumference and heart
rate, the two therapy groups were confronted, both genders, had not found the
statistically significant difference. The results of CHPs (Central Aortic Pressure,
End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation
Pressure), Diff-AIx, systolic and diastolic blood pressure during association of
ARBs+MRAs therapy compared to ARBs+CCBs, both genders, showed the low-
est values with a highly statistically significant difference.
Conclusions: These findings provide evidence that ARBs+MRAs treatment
reaches best haemodynamic conditions because improve the arterial stiffness
(Diff-AIx) and levels of pressures (CHPs) with the intention of giving to arterial-
ventricular coupling an adequate reducing the stress.
EFFECTS OF THE ANGIOTENSIN-CONVERTING ENZYME
INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS IN THE
CENTRAL BLOOD PRESSURE IN HYPERTENSIVE TREATED
E. Barbosa1, R. Fagundes2, L. Trarbach1, B. Finkler1, E. Eibel1, W. Sebba-Barroso2.
1Instituto de Cardiologia, Porto Alegre, BRAZIL, 2Universidade Federal de
Goiania, Goiania, BRAZIL
Objective: To verify the reduction of the central blood pressure and vascular
resistance in hypertensive patients treated with angiotensin-converting enzyme
inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), isolated or in as-
sociation.
Design and method: Retrospective cohort, in which the peripheral blood pres-
sure of the 346 hypertensive patients was the average of three measurements in
the office, following the guidelines of the Brazilian Hypertension Guidelines. The
central pressure parameters were verified by the oscillometric method with the
Mobil-O-Graphâ equipment, with triple shot protocol. The diagnosis of hyperten-
sion was determined by the use of antihypertensive drugs. Individuals using ACE
inhibitors or ARBs in isolated or combined therapy of both genders, aged over 18
years, were selected.
Results: The sample had a mean age of the 56.8 ± 15.5 years. The prevalence of
overweight was 41.6%, obesity 39.4%, smoking 3.9%, sedentary lifestyle 52.8%,
diabetes 20.2% and dyslipidemia 65.7%. Peripheral systolic blood pressures (125.3
- 128.3 mmHg, p = 0.097) were similar in the ACE inhibitors and ARBs groups,
while diastolic blood pressures were different intergroups. The central blood pres-
sure was lower in the ACE inhibitors group when compared to the ARBs group
(114.6 - 117.6 mmHg, p = 0.067). Regarding peripheral vascular resistance (1.18
- 1.23 units, p = 0.032), the ACE inhibitors group showed greater compliance.
Conclusions: Therefore, this cohort presented mean peripheral blood pressures
within the goals recommended by the guidelines, and a significant difference in
vascular resistance.
RESPONSES OF CARDIAC CONNEXIN-43 AND EXTRACELLULAR
MATRIX PROTEINS TO ALTERED THYROID STATUS DIFFER IN
HYPERTENSIVE VERSUS NORMOTENSIVE RATS
M. Sykora1, B. S. Bacova1, T. E. Benova1, M. Barancik1, J. Zurmanova2, H. Rau-
chova3, K. Frimmel1, S. Pavelka3, J. Slezak1, T. Soukup3, N. Tribulova1. 1 Institute
for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sci-
ences, Bratislava, Slovak Republic, 2Department of Physiology, Faculty of Sci-
ence, Charles University in Prague, Prague, CZECH REPUBLIC, 3Institute of
Physiology, Czech Academy of Sciences, v. v. i. , Prague, CZECH REPUBLIC
Objective: We aimed to explore impact of altered thyroid status on key factors
implicated in development of malignant arrhythmias, connexin-43 (Cx43) and
extracellular matrix proteins MMP2, SMAD2/3 and TGF.b1, in hypertensive ver-
sus normotensive rats. Moreover, we tested efficacy of omega-3 PUFA intake in
these conditions.
Design and method: Male spontaneously hypertensive rats (SHR) and age-
matched Wistar Kyoto rats (WKR) were divided into three groups: euthyroid con-
trols; hyperthyroid (HT) due to daily i.p. injection of T4 and T3; hypothyroid (HY)
due to drinking of methimazole, whereby each group included half of animals
that were treated daily with omega-3 PUFA (Omacor, 200 mg/kg) for 6weeks. At
the end of experiment rats were euthanized, blood samples were collected and the
heart was excised. Left ventricular tissue (LVW) was evaluated using RT-PCR,
Western blot, zymography, immunohistochemistry.
Results: There was no difference in circulating TH between SHR and WKR.
LVW was increased due to HT while decreased in HY rats regardless the strain.
Serum lipid peroxidation was increased in HT WKR but not in HT SHR. Total
cholesterol increased in HY WKR and HY SHR. Altered thyroid status did not
affect Cx43 mRNA in both strains but Cx43 protein and its functional phopshory-
lated forms were decreased in HT WKR and increased in HY WKR while there
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
were no changes in SHR. HY state did not suppress Cx43 phosphorylation in
SHR hearts unlike WKR. There were no differences in myocardial SMAD2/3 and
TGFb1 expression between strains. HT decreased and HY increased of SMAD2/3
as well as TGFb1 expression significantly only WKR. Myocardial MMP-2 ex-
pression was higher in SHR versus WKR regardless thyroid status. HT decreased
72kDa MMP-2 and increased 63kDa MMP-2 activity in WKR while the opposite
trend was found in HT SHR. Omacor intake did not affect significantly examined
parameter in any experimental group.
Conclusions: Hyperthyroid as well as hypothyroid status induced significant
changes in myocardial Cx43 as well as SMAD2/3 and TGFb1 expression in WKR
while not in SHR. It suggests distinct strain-related responses to altered thyroid
status, whereby rats adapted on hypertension are much less responsive. VEGA
2/0167/15,2/0076/16,2/0158/19; ITMS 26230120009
SYSTEMATIC REVIEW WITH NETWORK META-ANALYSIS:
COMPARATIVE EFFICACY AND SAFETY OF FIXED DOSE
COMBINATIONS OF ANGIOTENSIN II RECEPTOR BLOCKERS AND
AMLODIPINE IN ASIAN HYPERTENSION
D. W. Lee1, M. Jung1, H. Won Wang1, Z. Khan2, P. Pinton3. 1Takeda Pharmaceuti-
cal Ltd. , Medical Affairs, Seoul, South Korea, 2Health Economics and Outcomes
Research, Real World Insights, SINGAPORE, SINGAPORE, 3Takeda Pharmaceu-
tical Ltd. , Medical Affairs, Japan Pharma, Tokyo, Japan
Objective: Hypertension (HTN) is the leading risk factor for cardiovascular mor-
tality globally. Numerous studies have compared safety and efficacy between anti-
hypertensive classes, but in-class comparisons of angiotensin II receptor blockers
(ARBs) in fixed-dose combinations (FDC) with a calcium channel blocker (CCB)
are lacking in Asia. To compare the efficacy and safety of ARB FDCs against
amlodipine (AML) monotherapy for the treatment of Asian HTN.
Design and method: A systematic literature review sourced Asian random-
ized controlled trials (RCTs) from PubMed and Cochrane Libraries to inform
a network meta-analysis (NMA). We considered ARB-AML combinations. The
relative effects of interventions in term of odds ratio (OR), with 95% confidence
interval (CI) were estimated based on data reported by the individual studies. A
direct meta-analysis was applied for pooling of the effect estimates using a fixed-
effects model if more than one effect estimates were available per comparison.
The primary efficacy and safety endpoints responders were short term (8–12
weeks) treatment response, and treatment emergent adverse events (TEAE).
AML monotherapy was used as a comparator in the absence of RCTs comparing
ARB FDCs directly.
Results: The analysis included 1303 Asian HTN patients from seven studies in-
volving six ARBs: azilsartan (AZL), candesartan (CAN), fimasartan (FIM), losar-
tan (LOS), olmesartan (OLM), and telmisartan (TEL). Compared to AML mono-
therapy, FDC of AZL-AML had five times greater odds of prompting response (OR
5.2, 95%CI:2.6,11.0), while CAN-AML had 3.9 (95%CI:2.5,6.4), FIM-AML had
3.4 (95%CI:1.4,8.4), TEL-AML had 3.3 (95%CI: 1.6,7.0), OLM-AML had 2.8
(95%CI:1.6,4.9) and LOS-AML had 1.1 (95%CI:0.45,8.4) increased odds. All ARB-
AML FDCs had safety profiles comparable to AML monotherapy except TEL-AML
which had significantly lower odds of TEAEs (0.26 (95%CI: 0.087, 0.70)).
Conclusions: This study reveals that all ARB-AML FDCs compared favorably
to AML monotherapy regarding short-term treatment response in uncomplicated
Asian HTN patients. AZL-AML and LOS-AML prompted the most and least fa-
vorable treatment response respectively, and safety profiles were largely compa-
rable across treatments. This is among the first quantitative in-class comparisons
of ARB-AML FDCs using Asian RCT data. Further head-to-head trials may help
to confirm these results.
EFFECTS OF THE COMBINATIONS OF AMLODIPINE WITH AN
LISINOPRIL OR A CARVEDILOL IN PATIENTS WITH ARTERIAL
HYPERTENSION AND OBESITY
M. Bubnova, D. Aronov, V. Vygodin. National Medical Research Center For Pre-
ventive Medicine, Moscow, RUSSIA
Objective: To evaluate the effects of the combinations of Amlodipine/ Lisinopril
(A/L) and Amlodipine/ Carvedilol (A/C) on levels of blood pressure (BP), hyper-
tensive reaction under isometric exercise (IE), lipid and carbohydrate metabolism,
quality of life (QoL) in patients (pts) with arterial hypertension (AH) and obesity.
Design and method: 28 pts, mean age 57.8 ± 6.4years, were randomized into
two groups: 14 pts which received the combination A5 mg/L20 mg and 14 pts
which treated with the combination A5 mg /C50 mg. The duration of the study
was 6 weeks (wks). The trail includes clinical and ambulatory BP, an IE, the ques-
tionnaires QoL, to determine the concentration of lipids, glucose and insulin.