The effect of antihypertensive therapy on the levels of biomarkers of systemic inflammation in patients with hypertension

Objective: to determine the effect of renin-angiotensin-aldosterone system blockers in combination therapy with calcium channel blocker on the dynamics of systemic inflammatory biomarkers in patients with hypertension.

Materials and мethods: the study included 105 patients aged 18 to 60 years with stage I-II hypertension and ineffective blood pressure control (office blood pressure ≥ 140/90 mmHg). Patients were divided into 2 groups: group 1 received perindopril at an average dose of 5.94 ± 2.14 mg and amlodipine 6.07 ± 2.11 mg; group 2 received telmisartan 52.89 ± 19.6 mg and amlodipine 5.89 ± 1.93 mg in comparable doses (p = 0.075 for perindopril and telmisartan, p = 0.645 for amlodipine).

A clinical examination was performed at baseline and one year after taking the prescribed antihypertensive therapy; a complete blood count was performed with the calculation of hematological indices: systemic immune inflammation index; systemic inflammatory response index; neutrophil to lymphocyte ratio; platelet to lymphocyte ratio; lymphocyte-to-monocyte ratio; monocyte-to-high-density lipoprotein cholesterol ratio; lipidogram; determination of the concentration of high-sensitivity C-reactive protein, cystatin C, interleukin-1β, interleukin-6, interleukin-8, tumor necrosis factor-α, angiotensin II, and angiotensin-converting enzyme-2.

Results: in a comparative prospective analysis, office systolic and diastolic blood pressure levels significantly decreased in patients of both groups during antihypertensive therapy: in group 1 from 145.85 ± 19.54/93.13 ± 12.36 to 133.13 ± 12.36/83.87 ± 9.11 mmHg (p < 0.001), in the 2nd – from 146.10 ± 11.75/93.90 ± 9.77 to 128.44 ± 22.18/84.00 ± 9.29 mm Hg (p < 0.001).

In patients of group 1, there was a decrease in the blood content of interleukin-1β from 3.04 (1.84; 5.11) to 1.58 (0.88; 2.72) pg/ml (p = 0.003), interleukin-8 from 4.88 (4.27; 7.05) to 4.11 (2.53; 5.64) pg/ml (p = 0.007), cystatin C from 1.04 (0.93; 1.15) to 0.98 (0.87; 1.09) mg/ml (p < 0.001) and angiotensin II from 142974 (78048; 186608) to 101940 (54954; 153292) ng/ml (p = 0.016). In patients of group 2, there was a decrease in the level of interleukin-8 from 5.31 (3.88; 6.58) to 3.57 (2.42; 5.23) pg/ml (p < 0.001) and cystatin C from 1.03 (0.91; 1.12) to 0.95 (0.87; 1.06) mg/ml (p = 0.002).

Conclusions: in patients with hypertension, combined treatment with perindopril and amlodipine showed a decrease in the concentrations of interleukin-1β, interleukin-8, cystatin C, and angiotensin II over the course of a year. Patients taking telmisartan with amlodipine showed a decrease in interleukin-8 and cystatin C levels.

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