Influence of inhibitors of angiotensin-converting enzyme, sartan and surgical revascularization on vascular wall stiffness in patients with coronary heart disease in combination with chronic kidney disease

50% of all cardiovascular outcomes in patients with chronic kidney disease (CKD) fall into the share of coronary heart disease (CHD). The vascular wall stiffness is a common denominator when combined coronary heart disease and CKD.

Objective: determination of initial level of indicators of vascular wall stiffness in patients with chronic forms of CHD in combination with CKD of 1-3 degrees and also their dynamic control with different therapeutic approaches.

Materials and methods. 74 patients with chronic forms of CHD, I-III functional classes stable angina in combination with СKD of 1-3 degrees are examined. The regional stiffness of arteries was estimated by volumetric sphygmography by means of the VS-1500 device (Fucuda Denshi, Japan).

Results. Patients with coronary heart disease in combination with СKD develop a significant increase in pulse wave velocityand an increase in the augmentation index. Against the background of treatment all groups tend to normalize the indicators of vascular wall stiffness. It is most clearly seen when studying pulse wave velocity and CAVI. The conservative therapy with inhibitors of angiotensin-converting enzyme contributed to reducting pulse wave velocity by 2.3% within12 weeks of observation; in the group with surgical revascularization of myocardium – by 5.4%; and in using sartan – by 15.7% (p <0.05).

Conclusion. Determination of parameters of arterial stiffness, namely, speed of pulse wave velocity and CAVI, can be used as an objective marker for monitoring the efficiency of therapy in patients with coronary heart disease in combination with CKD. Carrying out revascularization of myocardium through stenting coronary arteries leads to normalization of stiffness indicators of the vascular wall to a greater extent than conservative tactics. Sartan within 12 weeks showed a significantly more favorable effect on the stiffness of the vascular wall in patients with comorbid pathology, than inhibitors of angiotensin-converting enzyme with other things being equal.