Renin-Angiotensin System Blockade Associated with Statin Improves Endothelial Function in Diabetics

Abstract

BackgroundStudies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness.ObjectiveTo analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness.MethodsPatients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively).ResultsThe SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586).ConclusionCombined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes.

Effects of combined statin and ACE inhibitor therapy on endothelial function and blood pressure in essential hypertension - a randomised double-blind, placebo controlled crossover study

“…They found that the combination of statins and ACEIs induced a greater increase in FMD than each medication alone. Similar results were obtained by Gismondi et al 33 who showed that a statin group showed a greater FMD response than a non-statin group. Tan et al 44 studied diabetes patients with dyslipidemia and found a marked improvement in FMD with atorvastatin compared with placebo.…”

“…Another study performed by Gismondi et al 33 showed that the combination of statins and RAAS inhibitors improved both BP control and endothelial function in diabetes patients with arterial hypertension. That study had some limitations as it was designed as an open randomised clinical trial that compared two active treatments.…”

Comparative effects of quercetin and hydroalcoholic extract of Otostegia persica boiss with atorvastatin on atherosclerosis complication in male wistar rats

“…Ronaldo Altenburg Gismondi et al found that anti‐hypertensive mechanisms of statins in reducing pulse rate resulting from lower arterial contraction due to the increased nitric oxide bioavailability increased endothelial‐dependent vasodilatation and decreased endothelin‐1 concentrations. In addition, they predicted that statins were RAAS (renin–angiotensin–aldosterone system) inhibitors that could block intracellular pathways associated with angiotensin II and could also reduce the expression of type 1 angiotensin receptors, and result in decreasing blood pressure (Gismondi et al, ).…”

“…It increases systolic, diastolic, mean arterial, and pulse pressure. predicted that statins were RAAS (renin-angiotensin-aldosterone system) inhibitors that could block intracellular pathways associated with angiotensin II and could also reduce the expression of type 1 angiotensin receptors, and result in decreasing blood pressure (Gismondi et al, 2015).…”

Possibilities for correcting endothelial dysfunction in patients with arterial hypertension and coronary heart disease

“…Статины, несмотря на отсутствие антигипертензивного эффекта, также способны улучшать функцию эндотелия. Причем эффект тем выраженнее, чем больше доза препарата и если он используется совместно с блокатором РААС [16,17].…”