Effects of Antihypertensive Drugs on Central Blood Pressure in Humans: A Preliminary Observation

Agnoletti, Davide; Zhang, Yi; Borghi, Claudio; Blacher, Jacques; Safar, Michel E.

doi:10.1093/ajh/hpt081

Cited by 32 publications

(27 citation statements)

References 33 publications

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“…Some studies have shown different effects of antihypertensive treatment on central and brachial blood pressure. 18,19 However, recently the X-CELLENT study was unable to show different central and peripheral blood pressure effects by indapamid, candesartan, and amlodipine, 20 as did the CHAMPION trial comparing beta-blockers with different receptor affinities. 21 Thus, some, but not all, antihypertensive medications may exert different effects on central and brachial blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Central Hemodynamics Are Associated With Cardiovascular Disease and Albuminuria in Type 1 Diabetes

Theilade

Hansen

Rossing

2014

American Journal of Hypertension

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backgroundWe sought to investigate associations between central hemodynamic parameters (estimated from radial pulse wave analyses (PWAs)), cardiovascular disease (CVD), and albuminuria in type 1 diabetes. methodsWe conducted an observational study of 636 type 1 diabetes patients. Central hemodynamics were measured by PWA as central aortic systolic pressure (CASP), central aortic pulse pressure (CPP), central aortic diastolic pressure (CADP), and subendocardial viability ratio (SEVR). CVD included revascularization, myocardial infarction, peripheral arterial disease, and stroke. Albuminuria was urinary albumin excretion rate ≥30 mg/24 hours. We computed standardized odds ratios (ORs) adjusted for sex, age, mean arterial pressure (MAP), heart rate, height, estimated glomerular filtration rate, glycated hemoglobin (HbA 1c ) total cholesterol, antihypertensive medication, and smoking. At follow-up, development of end-stage renal disease (ESRD) and mortality was traced through electronic medical records. resultsPatients were aged a mean of 54 ± 13 years, and 289 (45%) were women. The mean ± SD was 118 ± 17 mm Hg for CASP, 75 ± 10 mm Hg for CADP, 43 ± 14 mm Hg for CPP, and 150 ± 32 for SEVR. In fully adjusted models, increased CASP and CPP and decreased CADP and SEVR were associated with presence of CVD (n = 132; P ≤ 0.02) and presence of albuminuria (n = 335; P < 0.001). During follow-up, median (range) (2.8 (0.7-3.8) years), SEVR predicted ESRD or mortality combined (n = 26) after adjustment for sex, age, and MAP (P = 0.001), whereas CASP, CPP, and CADP did not (P ≥ 0.13). conclusionsIn type 1 diabetes patients, increased CASP and CPP and decreased CADP and SEVR were independently associated with history of CVD and albuminuria. Furthermore, SEVR predicted mortality and ESRD during follow-up. Future studies are needed to determine whether targeting central hemodynamics improves outcome.

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Section: Discussionmentioning

confidence: 99%

Central Hemodynamics Are Associated With Cardiovascular Disease and Albuminuria in Type 1 Diabetes

Theilade

Hansen

Rossing

2014

American Journal of Hypertension

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“…When valsartan was compared to captopril, the two drugs equally reduced PWV as well as Aix [42]. As far as Aix reduction is concerned, losartan (see the LIFE (Losartan Intervention For Endpoint reduction in hypertension) [43] and OPTIMAAL (Optimal Trial in Myocardial Infarction with Angiotensin Antagonist Losartan) [44] studies) and candesartan [45, 46] were proven to reduce it. Other ARBs, such as valsartan (the VALUE (Valsartan Antihypertensive Long-Term Use Evaluation) study) [47–49], olmesartan [50], telmisartan [51], and eprosartan [52], were proven to reduce central blood pressure more than the systolic blood pressure and increase pulse pressure, while reducing Aix and PWV.…”

Section: Influence Of Drugs On Arterial Stiffnessmentioning

confidence: 99%

“…The largest amount of evidence is for the dihydropyridine calcium channel blocker amlodipine [32, 34, 37, 46, 49, 55]. This drug was evaluated in the CAFÉ study, among other trials, where it proved to reduce central blood pressure more than peripheral blood pressure; it amplified pulse pressure and reduced Aix and PWV, thus displaying its destiffening effect [32].…”

Section: Influence Of Drugs On Arterial Stiffnessmentioning

confidence: 99%

“…Many agents were studied, including hydrochlorothiazide, which showed a neutral effect on reduction of central blood pressure and a neutral effect on pulse pressure amplification [37, 55]. Consistent data is available for bendrofluazide [34, 59, 61, 113] and indapamide [37, 46, 113, 114], which also have a neutral effect on Aix and PWV, respectively.…”

Section: Influence Of Drugs On Arterial Stiffnessmentioning

confidence: 99%

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Arterial Stiffness and Cardiovascular Therapy

Janić

Lunder

Šabovič

2014

BioMed Research International

119

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The world population is aging and the number of old people is continuously increasing. Arterial structure and function change with age, progressively leading to arterial stiffening. Arterial stiffness is best characterized by measurement of pulse wave velocity (PWV), which is its surrogate marker. It has been shown that PWV could improve cardiovascular event prediction in models that included standard risk factors. Consequently, it might therefore enable better identification of populations at high-risk of cardiovascular morbidity and mortality. The present review is focused on a survey of different pharmacological therapeutic options for decreasing arterial stiffness. The influence of several groups of drugs is described: antihypertensive drugs (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, diuretics, and nitrates), statins, peroral antidiabetics, advanced glycation end-products (AGE) cross-link breakers, anti-inflammatory drugs, endothelin-A receptor antagonists, and vasopeptidase inhibitors. All of these have shown some effect in decreasing arterial stiffness. Nevertheless, further studies are needed which should address the influence of arterial stiffness diminishment on major adverse cardiovascular and cerebrovascular events (MACCE).

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“…Subgroup analysis by the type of drugs taken by controls revealed significant reductions in SBP for comparisons of ARBs with placebo (WMD = − 3.81 mm Hg; 95% CI: − 6.70 to − 0.91; P = 0.010; I 2 = 77.2%) and diuretics (WMD = − 1.31 mm Hg; 95% CI: − 2.33 to − 0.27; P = 0.013; I 2 = 0.0%), and reductions in diastolic blood pressure for placebo 23 Caucasian Hypertension cfPWV Parallel Open Candesartan Placebo 33 35 12 Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; baPWV and cfPWV, brachial-ankle and carotid-femoral pulse wave velocity; CCB, calcium channel blocker; NA, not available; RAS, renin-angiotensin system.…”

Section: Changes In Pulse Wave Velocitymentioning

confidence: 99%

The impact of angiotensin receptor blockers on arterial stiffness: a meta-analysis

et al. 2015

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Some studies reported a protective role of angiotensin receptor blockers (ARBs) against arterial stiffness. Therefore, we performed a meta-analysis of published clinical trials to systematically assess the impact of ARBs on arterial stiffness as measured by using pulse wave velocity (PWV). Eligible articles were identified by searching PubMed, EMBASE, Cochrane, Wanfang and CNKI databanks before 31 July 2014. The data were extracted independently and in duplicate. Forty articles including 53 clinical trials qualified, including 1650 and 1659 subjects in ARB treatment and control groups, respectively. Overall reductions in carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV) were statistically significant, with an average of -42.52 cm s(-1) (95% CI: -81.82 to -3.21; P=0.034) and -107.08 cm s(-1) (95% CI: -133.98 to -80.18; P<0.0005), respectively, after receiving ARBs. Subgroup analysis by ARB type revealed that telmisartan (weighted mean difference or WMD=-100.82 cm s(-1); P<0.0005) and valsartan (WMD=-104.59 cm s(-1); P<0.0005) significantly reduced baPWV, but only valsartan reduced cfPWV (WMD=-65.58; P=0.030). cfPWV was significantly reduced in comparisons of ARBs with placebo (WMD=-79.65 cm s(-1); P=0.001), and baPWV was significantly reduced with calcium channel blockers (WMD=-130.74 cm s(-1); P<0.0005). There were low probabilities of publication bias. Taken together, our findings support the important role of ARB treatment in improving arterial stiffness.

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Effects of Antihypertensive Drugs on Central Blood Pressure in Humans: A Preliminary Observation

Cited by 32 publications

References 33 publications

Central Hemodynamics Are Associated With Cardiovascular Disease and Albuminuria in Type 1 Diabetes

Central Hemodynamics Are Associated With Cardiovascular Disease and Albuminuria in Type 1 Diabetes

Arterial Stiffness and Cardiovascular Therapy

The impact of angiotensin receptor blockers on arterial stiffness: a meta-analysis

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