Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.

London, Gérard M.; Pannier, Bruno; Guérin, Alain P.; Marchais, Sylvain J.; Safar, Michel E.; Cuche, Jean-Louis

doi:10.1161/01.cir.90.6.2786

Cited by 310 publications

(197 citation statements)

References 63 publications

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“…In patients with mild essential hypertension both enalapril and indapamide reduce brachial BP, mean arterial pressure and pulse pressure, with more pronounced effects on central BP and pulse pressure with enalapril compared to indapamide. Enalapril was also associated with improvements in augmentation index, In patients with end-stage renal disease, nitrendipine significantly reduces brachial and central BP, as well as improving PWV and augmentation index, suggesting reduced arterial stiffness 69,143 . In elderly patients with untreated essential hypertension, both felodipine and amlodipine showed a more pronounced effect on central than brachial BP as well as improvements in pulse pressure and augmentation index compared to placebo 69,124 .…”

Section: Ace Inhibitors and Angiotensin II Receptor Blockersmentioning

confidence: 88%

Drug Treatment of Hypertension: Focus on Vascular Health

Cameron

Lang

Touyz

2016

Drugs

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Hypertension, the most common preventable risk factor for cardiovascular disease and death, is a growing health burden. Serious cardiovascular complications result from target organ damage including cerebrovascular disease, heart failure, ischaemic heart disease and renal failure. While many systems contribute to blood pressure elevation, the vascular system is particularly important, because vascular dysfunction is a cause and consequence of hypertension. Hypertension is characterised by a vascular phenotype of endothelial dysfunction, arterial remodelling, vascular inflammation and increased stiffness. Antihypertensive drugs that influence vascular changes associated with high blood pressure have greater efficacy for reducing cardiovascular risk than drugs that reduce blood pressure but have little or no effect on the adverse vascular phenotype. Angiotensin converting enzyme Key Points• Hypertension is characterized by a vascular phenotype of endothelial dysfunction and structural remodeling.• Anti-hypertensive drugs that target the vascular changes associated with hypertension appear to be most efficacious• New anti-hypertensive drugs should promote vascular health as well as reducing blood pressure 3

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Section: Ace Inhibitors and Angiotensin II Receptor Blockersmentioning

confidence: 88%

Drug Treatment of Hypertension: Focus on Vascular Health

Cameron

Lang

Touyz

2016

Drugs

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“…Attenuation or regression of LVH with treatment can have an independent and favorable impact on all-cause mortality and cardiovascular mortality in patients with ESRD (32). Treatment of hypertension and anemia has been shown to decrease LV mass and have a positive impact on survival.…”

Section: Clinical Impact Of Aortic Stiffnessmentioning

confidence: 99%

Cardiovascular Calcifications in Uremic Patients

London

2003

Journal of the American Society of Nephrology

193

137

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Abstract. Cardiovascular disease is the leading cause of mortality among patients with ESRD (chronic kidney disease stage 5). Left ventricular hypertrophy and arterial diseases are the two principal risk factors for cardiovascular mortality in hemodialysis patients. Epidemiologic studies show that damage to large conduit arteries contributes to morbidity and mortality in patients with chronic kidney disease. Atherosclerosis is primarily an intimal disease characterized by the presence of plaques and occlusive lesions. Although atherosclerosis is the most frequent underlying cause of cardiovascular disease in patients with ESRD, it represents only one form of structural response to metabolic and hemodynamic alterations that interfere with the process of aging. Arterial alterations in ESRD include nonocclusive arterial remodeling accompanying the growing hemodynamic burden and humoral abnormalities that are associated with chronic uremia. The consequences of these alterations are different from those attributed to atherosclerotic plaques and are characterized principally by hardening (stiffening) of arteries. Arteriosclerosis, characterized by stiffening of the aorta and large capacitative arteries, is a major determinant of left ventricular pressure overload and of abnormal coronary perfusion. Atherosclerosis and arteriosclerosis are frequently comorbid and characterized by a high degree of both intimal and medial calcifications in patients with ESRD. The extent of calcifications and the degree of arterial stiffening are independent predictors of mortality. Studies in patients with ESRD have shown that attenuation of arterial stiffness can have a favorable effect, associated with regression of left ventricular hypertrophy, on survival. Calciumfree, metal-free phosphate binders such as sevelamer can reduce calcification scores.

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“…Aortic PWV was determined by the foot-to-foot method. 15,16 For this purpose, CCA and femoral artery pressure waveforms were recorded noninvasively with a pencil-type probe incorporating a high-fidelity Millar strain-gauge transducer in the tip of the probe (SPT-301, Millar Instruments). Pressure waveform recordings were carried out simultaneously at the base of the neck over the CCA and the femoral artery in the groin and recorded with a Gould 8188 recorder (Gould Electronique) at a speed of 100 mm/s.…”

Section: Study Design and Arterial And Cardiac Measurementsmentioning

confidence: 99%

Influence of Biochemical Alterations on Arterial Stiffness in Patients With End-stage Renal Disease

Blacher

Demuth

Guérin

et al. 1998

ATVB

190

115

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Abstract-The incremental elastic modulus of the common carotid and radial arteries is increased in patients with end-stage renal disease (ESRD), independently of blood pressure, wall stress, and the presence of atherosclerotic alterations. Whether biochemical factors may be involved in the arterial changes and related to renal dysfunction remain largely ignored. To assess this question, we measured aortic (carotid-femoral), upper-limb (carotid-radial), and lower-limb (femoral-tibial) pulse wave velocity (PWV) in 74 ESRD patients undergoing hemodialysis in comparison with 57 control subjects similar in age, sex ratio, and mean blood pressure. We evaluated arterial blood presure by sphygmomanometry, aortic calcifications and cardiac mass by echography, and routine biochemical parameters, total plasma homocysteine, and plasma endothelin levels by standard techniques. In the population of patients with ESRD, on the basis of multiple stepwise regression analysis, aortic PWV was positively and independently correlated with systolic blood pressure (PϽ.0001), age (PϽ.0001), prevalence of aortic calcification (Pϭ.0004), and the prevalence of diabetes mellitus (Pϭ.0043). Upper-limb PWV was influenced exclusively by mean blood pressure (PϽ.0001). Lower-limb PWV was positively and independently correlated with plasma total homocysteine (Pϭ.0004) and plasma endothelin (Pϭ.0187) only. At any vascular site, PWV was not independently correlated with tobacco consumption; plasma levels of cholesterol, triglyceride, fibrinogen, or hemoglobin; body mass index; or the presence of bilateral nephrectomy. Finally, plasma homocysteine was independently correlated with cardiac mass (Pϭ.0022). This study provides evidence that in ESRD patients, the stiffness of the arterial wall and cardiac mass are strongly influenced by biochemical factors related to the kidney alterations and are independent of age and blood pressure level. Increased plasma endothelin and homocysteine may be specifically involved in the vascular damage of lower limbs. (Arterioscler Thromb Vasc Biol. 1998;18:535-541.)

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Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.

Cited by 310 publications

References 63 publications

Drug Treatment of Hypertension: Focus on Vascular Health

Drug Treatment of Hypertension: Focus on Vascular Health

Cardiovascular Calcifications in Uremic Patients

Influence of Biochemical Alterations on Arterial Stiffness in Patients With End-stage Renal Disease

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