Dihydropyridine calcium channel blockers may possess
antioxidant properties, and might improve micro and macrovascular structure and function. Combination treatment with an
ACE inhibitor may have additional advantages, compared with a
thiazide diuretic. The aim of the present study is to investigate the effects of a short-term treatment with
lercanidipine, and to compare two combination treatments: lercanidipine + enalapril vs. lercanidipine + hydrochlorothiazide on structural alterations in
retinal arterioles, on skin capillary density and on large artery distensibility. Thirty
essential hypertension patients are included in the study, and treated for 4 weeks with
lercanidipine 20 mg per day orally. Then, they were treated for 6 months with lercanidipine + enalapril (n = 15) or lercanidipine + hydrochlorothiazide (n = 15) combinations. Investigations were performed on basal condition, after appropriate wash out of previous treatments, after 4 weeks of
lercanidipine monotherapy treatment, and at the end of the combination treatment. Non-invasive measurements of wall-to-lumen ratio (WLR) and other morphological parameters of
retinal arterioles were performed using either scanning
laser Doppler flowmetry or adaptive optics. Capillary density was evaluated by capillaroscopy, while pulse wave velocity was measured, and central blood pressures were assessed by pressure waveform analysis. A significant improvement of WLR and other indices of retinal artery structure is observed with both technical approaches
after treatment with
lercanidipine alone, with a further improvement
after treatment with lercanidipine + enalapril, while
after treatment with lercanidipine + hydrochlorothiazide, the improvement is partially blunted. Central systolic and diastolic blood pressures are similarly reduced by both therapeutic strategies. Capillary density is increased only
after treatment with lercanidipine + enalapril. In conclusion,
lercanidipine both in monotherapy and in combination with
enalapril but not with
hydrochlorothiazide is able to improve microvascular structure; on the other hand, a decrease in central blood pressure is observed with both therapeutic combinations.