Our aim was to compare the changes of arterial stiffness (AS), endothelial function (EF) and metabolic parameters in patients with essential hypertension on treatment with combination of perindopril with either indapamide-retard or hydrochlorothiazide. The study involved 40 patients (mean age 52,4±7,1 years) who were randomly assigned to perindopril 5–10 mg o.d. in combination with indapamide-retard (P+IR) 1.5 mg o.d. (n=20) or with hydrochlorothiazide (P+HT) 25 mg o.d. (n=20). EF determined as the change of resistance index after inhalation of 400 mcg of salbutamol, AS measured as mean stiffness index after 500 mcg of sublingual trinitroglycerin (SI_tng), blood lipids and glucose were evaluated at baseline and 6 months thereafter. Vascular responses were calculated from digital pulse waves registered using photoplethysmography. Dynamics of BP after 6 months did not differ significantly between groups (−19.3% versus −19,2% and −16.2% versus −14.1% for systolic and diastolic BP on P+IR and P+HT, respectively, p<0.001 for all). Changes of vascular and metabolic parameters are depicted in the table.

Arterial stiffness significantly decreases on both regiments of treatment with the trend in favor of P+IR. Treatment with combination of P+HT resulted in significant decrease of EF accompanied by negative changes of triglycerides and glucose levels, whereas combination of P+IR did not affect endothelial function and was metabolically neutral.

Thus, despite the similar BP reduction the combinations of ACE-inhibitor – perindopril with two different diuretics significantly differ in vascular and metabolic effects. Worsening of endothelial function on P+HT combination may be attributed to negative metabolic effects of hydrochlorothiazide.