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

Abstract

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.

Do arterial stiffness and wave reflections improve more with angiotensin receptor blockers than with other antihypertensive drug classes?

“…At variance from the meta-analysis of Chen, Yen and coworkers assessed the effect on arterial stiffness separately by carotid-femoral and brachial-ankle PWV. A more recent large meta-analysis of randomized trials comparing the ARB treatment with placebo or other types of drugs, showed a significant effect of ARBs on both carotidfemoral and brachial-ankle PWV (8). At variance from the meta-analyses of Yen (7) and Chen (1), this systematic review was based on a large number of studies (n=40), did not exclude patients with co-morbidities and was characterized by a long duration of the follow-up (18.8 months on average; range, 2-48 months).…”

Arterial stiffness and increased cardiovascular risk in chronic kidney disease

“…In high-risk patients with end-stage renal failure, ACE inhibitors effectively decreased arterial stiffness and had a favorable effect on survival which was independent of changes in blood pressure [73]. A recent meta-analysis including qualified clinical trials and 1650 and 1659 subjects in ARB treatment and control groups has supported an important role of ARB treatment in improving arterial stiffness [74]. Another meta-analysis summarizing [75].…”

“…Drugs currently approved to be effective for treating hypertension were explored whether they could substantially reduce AS. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARB), low-dose diuretics, calcium channel antagonists, and some beta-blockers have been proved to have favorable effects on arterial stiffness (Table 2) [73,[74][75]. In high-risk patients with end-stage renal failure, ACE inhibitors effectively decreased arterial stiffness and had a favorable effect on survival which was independent of changes in blood pressure [73].…”

Antihypertensive drugs and statins should be considered in arterial stiffness evaluation in ethnic differences

“…In addition to angiotensin-converting enzyme inhibitors, beta blockers and aliskiren, a direct renin inhibitor, also reduce arterial stiffness [5]. Recent metaanalysis showed that angiotensin receptor blocker treatment also improves arterial stiffness [6]. It has also been shown that statins reduce arterial stiffness but there is also no data regarding statin use [3].…”