Effect of Renin–Angiotensin System Inhibition on Cardiovascular Events in Older Hypertensive Patients with Metabolic Syndrome

Abstract

Objective Metabolic syndrome (MetS) is associated with cardiovascular disease (CVD). Insulin resistance has been hypothesized as the underlying feature of MetS. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are widely used antihypertensives that may improve insulin sensitivity. The aim of the study is to evaluate the effect of ACEI/ARB on incident CVD events in older hypertensive patients with MetS. Materials/Methods We used the Cardiovascular Health Study, a prospective cohort study of individuals > 65 years of age to evaluate ACEI/ARB use and time to CVD events (including coronary and cerebrovascular events). The study included 777 subjects who had hypertension and ATP III-defined MetS, but free of CVD and diabetes at baseline. Cox regression models were used to evaluate the effect of ACEI/ARB as compared to other antihypertensives on the time to the first CVD events. Results ACEI/ARB use was associated with a decreased risk of CVD events (adjusted HR=0.658, 95 % C.I. [0.436-0.993]) compared to other antihypertensives. When CVD endpoints were evaluated separately, use of ACEI/ARB was associated with lower rates of angioplasty and coronary events (HR of 0.129 and 0.530 respectively, with 95 % CI [0.017-0.952] and [0.321-0.875]). Conclusions ACEI/ARB use was associated with a lower risk of CVD events in older hypertensive patients with MetS, primarily due to a reduction in coronary events. The potential protective effect of ACEI/ARB on CVD events in older individuals with MetS will need further confirmation from prospective studies.

Association of polymorphisms within the Renin-Angiotensin System with metabolic syndrome in a cohort of Chilean subjects

“…For instance, Zreikat and cols. in a cohort of 777 hypertensive patients with MetS observed that ACEi or ARB users would have a decreased risk of cardiovascular events, particularly coronary events (27).…”

Pharmacological treatment and therapeutic perspectives of metabolic syndrome

“…ARBs have good tolerability and safety profile, which have been reported to be similar to placebo [117]. A recent analysis with Cardiovascular Health Study showed that RAS blocking agents reduced cardiovascular events in patients with metabolic syndrome [118]. Thus, RAS blockers are indicated for the treatment of elevated blood pressure in people with metabolic syndrome.…”

Évaluation de la tension artérielle et de la pression du pouls dans le syndrome métabolique

“…La rigidité artérielle augmente avec l'âge, conduisant au rétrécissement de la taille artériolaire, ce qui a pour conséquence une augmentation considérable de la pression différentielle et l'amélioration de l'hypertension artérielle moyenne [30][31][32] . Cette augmentation de la pression pouls reflète l'augmentation de la pression artérielle systolique et la chute de la diastolique, chacun de ces deux facteurs étant une conséquence de la rigidité accrue des grandes artères 31 être utilisée comme un indicateur subclinique de la rigidité artérielle de l'athérosclérose 29 .…”