The impact of fixed-dose anatihypertensive therapy on cardiorenal syndrome markers in patients with acute coronary syndrome and comorbidities

Abstract

Introduction: The problem of cardiorenal syndrome (CRS) in patients with acute coronary syndrome (ACS) and arterial hypertension (AH) is highly relevant. Early diagnosis, based on cystatin C, microalbuminuria, and arterial stiffness, is key for prognosis and therapy selection. Aim: To assess CRS marker dynamics and arterial stiffness in patients with ACS, AH, and chronic kidney disease (CKD) on standardized therapy, and to develop a treatment selection algorithm.

Materials and Methods: A prospective study included 148 patients after percutaneous coronary intervention for ACS with AH. The main group (n=118) had CKD stages 2-3; controls (n=30) had no CKD. All received initial therapy with a fixed-dose combination of amlodipine 5 mg/perindopril 5 mg once daily, with possible uptitration to a triple combination including indapamide 1.25 mg (amlodipine 5 mg/perindopril 5 mg/indapamide 1.25 mg once daily). Markers were assessed at days 10-12 and 3 months.

Results: Cystatin C and microalbuminuria correlated with ACS severity and arterial stiffness. After 3 months, the main group showed significant improvement: cystatin C decreased from 1.35±0.33 to 1.02±0.29 mg/L; microalbuminuria – from 41.24±3.56 to 25.56±2.99 mg/L; pulse wave velocity – from 9.31 to 8.20 m/s (all p<0.001). Triple therapy provided a more pronounced effect. Baseline cystatin C >1.3 mg/L and microalbuminuria >30 mg/L are criteria for considering early triple therapy initiation.

Conclusion: Standardized therapy with perindopril/amlodipine, with the possible addition of indapamide, significantly improves cardiorenal status and vascular stiffness. The developed algorithm, based on initial biomarkers, allows for a personalized approach to managing these comorbid patients.

Graphical Abstract