Different actions of losartan and ramipril on adipose tissue activity and vascular remodeling biomarkers in hypertensive patients

Abstract

We planned a randomized, double blind clinical trial to evaluate whether an antihypertensive intervention at the proximal or distal level of the renin-angiotensin-aldosterone system could have different effects on a broad range of innovative cardiovascular risk biomarkers. A total of 288 hypertensive Caucasian patients (115 men and 113 women), aged X18 years, were enrolled in this study. They were randomized to take losartan 50 mg per day or ramipril 5 mg per day for 1 month and titrated up to 100 mg per day and 10 mg per day for 13 months, respectively. At baseline, 1, 2 and 14 months after therapy initiation, we evaluated the following parameters: body weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), M-value, adiponectin (ADN), resistin (r), retinol binding protein-4 (RBP-4), visfatin, vaspin, high-sensitivity C-reactive protein (Hs-CRP), matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9). No variation of body weight, BMI, FPG or vaspin was obtained with either treatment. We recorded a similar improvement in SBP, DBP and Hs-CRP with both treatments; however, losartan also increased M-value, ADN and visfatin, whereas ramipril did not. Furthermore, losartan decreased r, RBP-4, MMP-2 and MMP-9, whereas ramipril did not have any effect on these parameters. In conclusion, we observed that short-term treatment with losartan improved several metabolic parameters (M-value, ADN, RBP-4, r and visfatin) and decreased vascular remodeling biomarkers (MMP-2 and MMP-9) in hypertensive subjects, whereas ramipril did not.

Angiotensin II receptor blockade and insulin sensitivity in overweight and obese adults with elevated blood pressure

“…The results of some randomized controlled trials have reported increases in insulin sensitivity with ARB treatment compared with other antihypertensive treatments. [37][38][39][40][41][42][43][44] Conversely, our study and others demonstrated no change in whole-body insulin sensitivity measures during RAS. [45][46][47][48][49] The reason for this apparent discrepancy is unclear but differences in the particular ARB used, duration of treatment, methods used to assess insulin sensitivity, and/or study population may contribute.…”

The Effect of Sodium Restricted Diet on Plasma Visfatin Levels in Hypertensive Patients with Visceral Obesity

“…However, results obtained in further studies weren't so clear. Ferrari et al [9] showed the increase in plasma visfatin concentration after treatment with angiotensin II receptor AT 1 inhibitors, but not after using ACE-Is in 288 hypertensive patients. Contrary Eyileten et al [10] have showed the decrease of plasma visfatin concentration after treatment with ACE-Is in patients with diabetic nephropathy.…”

“…In few studies the effect of pharmacological blockade of RAA system on plasma visfatin level was described [8,9,10]. In the first study both the angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin II receptor AT1 inhibitors use was followed by the increase of visfatin secretion from endothelial cells, adipocytes and myocytes [8].…”

“…Storka et al [8] observed that both ACE-Is and ARBs in diabetic patients increase circulating visfatin levels. Ferrari et al [9] showed that treatment of hypertensive patients with ARBs but not ACE-Is increase visfatin level. Additionally, Eyileten et al [10] observed decrease of circulating visfatin levels during ACE-Is therapy in patients with diabetic nephropathy.…”

The Effects of Antihypertensive Agents in Metabolic Syndrome – Benefits Beyond Blood Pressure Control

“…Within CCBs, candesartan, but not olmesartan therapy, over the period of a year resulted in increased adiponectin and insulin sensitivity in T2DM hypertensive patients, even though BP lowering was similar in both treatment groups [109]. When compared to the ACEI ramipril, losartan treatment significantly improved adiponectin levels and overall metabolic parameters while ramipril had no effect on adiponectin or any other metabolic markers [131]. In obese hypertensive patients, telmisartan, but not losartan raised serum adiponectin levels [132].…”