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Lieb W, Larson MG, Benjamin EJ, Yin X, Tofler GH, Selhub J, Jacques PF, Wang TJ, Vita JA, Levy D, Vasan RS, Mitchell GF. Multimarker approach to evaluate correlates of vascular stiffness: the Framingham Heart Study. Circulation 2008; 119:37-43. [PMID: 19103986 DOI: 10.1161/circulationaha.108.816108] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial stiffness increases with age and contributes to the pathogenesis of systolic hypertension and cardiovascular disease in the elderly. Knowledge about the pathophysiological processes that determine arterial stiffness may help guide therapeutic approaches. METHODS AND RESULTS We related 7 circulating biomarkers representing distinct biological pathways (C-reactive protein, aldosterone-to-renin ratio, N-terminal proatrial natriuretic peptide and B-type natriuretic peptide, plasminogen activator inhibitor-1, fibrinogen, and homocysteine) to 5 vascular function measures (central pulse pressure, carotid-femoral pulse-wave velocity, mean arterial pressure, forward pressure wave amplitude [all measures of conduit artery stiffness], and augmented pressure, an indicator of wave reflection) in 2000 Framingham Offspring Study participants (mean age, 61 years; 55% women). Tonometry measures were obtained on average 3 years after the biomarkers were measured. In multivariable linear regression models adjusting for covariates, the biomarker panel was significantly associated with all 5 vascular measures (P<0.003 for all). On backward elimination, the aldosterone-to-renin ratio was positively associated with each stiffness measure (P< or =0.002 for all). In addition, C-reactive protein was positively related to augmented pressure (P=0.0003), whereas plasminogen activator inhibitor-1 was positively associated with mean arterial pressure (P=0.003), central pulse pressure (P=0.001), and forward pressure wave (P=0.01). CONCLUSIONS Our cross-sectional data on a community-based sample suggest a distinctive pattern of positive associations of biomarkers of renin-angiotensin-aldosterone system activation with pan-arterial vascular stiffness, plasminogen activator inhibitor-1 with central vascular stiffness indices, and C-reactive protein with wave reflection. These observations support the notion of differential influences of biological pathways on vascular stiffness measures.
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Ichihara A, Yamashita N, Takemitsu T, Kaneshiro Y, Sakoda M, Kurauchi-Mito A, Itoh H. Cardio-ankle vascular index and ankle pulse wave velocity as a marker of arterial fibrosis in kidney failure treated by hemodialysis. Am J Kidney Dis 2008; 52:947-55. [PMID: 18760518 DOI: 10.1053/j.ajkd.2008.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 06/01/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with kidney failure treated with hemodialysis have a high incidence of cardiovascular diseases caused by accelerated arteriosclerosis. However, accurate evaluation of the extent of arteriosclerosis is difficult. This study sought to compare the strength of predictions of arterial fibrosis by using a new parameter, the cardio-ankle vascular index (CAVI), versus pulse wave velocity (PWV) in patients with kidney failure treated with hemodialysis. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS 103 patients with kidney failure undergoing surgical construction of an arteriovenous access for hemodialysis therapy. INDEX TEST CAVI and PWV. REFERENCE TEST Arterial fibrosis, evaluated by using Masson trichrome stain on part of the brachial artery obtained during surgery, expressed as percentage of fibrosis of the layer of vascular smooth muscle cells. RESULTS Median percentage of arterial stiffness was 52.85%. Mean PWV and CAVI were 18.3 +/- 5.6 (SD) m/s and 9.9 +/- 2.6, respectively. Multivariate regression analysis showed that arterial fibrosis was significantly associated with older age (0.247%/y; 95% confidence interval, 0.013 to 0.482) and CAVI (6.117%/unit; 95% confidence interval, 4.764 to 4.740), but not with systolic blood pressure (0.039%/mm Hg; 95% confidence interval, -0.076 to 0.153) or PWV (-0.044%/m/s; 95% confidence interval, -0.646 to 0.558). The area under the receiver operating characteristic curve to predict greater than median percentage of arterial stiffness was 0.892 for CAVI and 0.779 for PWV (P = 0.006). LIMITATION It is unclear whether arterial fibrosis of the brachial artery evaluated by using CAVI is applicable for arteriosclerosis of other arterial districts, and clinical outcomes were not evaluated in this study. CONCLUSION CAVI reflects the histological arterial fibrosis of hemodialysis patients and is a useful clinical marker for evaluating arterial stiffness in these patients.
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Affiliation(s)
- Atsuhiro Ichihara
- Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
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Nakou E, Filippatos TD, Liberopoulos EN, Tselepis AD, Kiortsis DN, Mikhailidis DP, Elisaf MS. Effects of sibutramine plus verapamil sustained release/trandolapril combination on blood pressure and metabolic variables in obese hypertensive patients. Expert Opin Pharmacother 2008; 9:1629-39. [PMID: 18570597 DOI: 10.1517/14656566.9.10.1629] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The management of obese hypertensive subjects may require the administration of anti-obesity and antihypertensive drugs. Sibutramine use has raised concerns regarding a potential increase in subjects' blood pressure and heart rate. The primary end-points of this study were an evaluation of the effect of sibutramine together with a verapamil sustained release/trandolapril combination tablet versus verapamil sustained release/trandolapril alone on the blood pressure and heart rate in obese hypertensive patients. RESEARCH DESIGN/METHODS Patients received a low-fat low-calorie diet and were randomly allocated to open-label verapamil sustained release/trandolapril 180/2 mg (n = 26) or sibutramine 10 mg together with verapamil sustained release/trandolapril 180/2 mg (n = 28) daily for 6 months. RESULTS Significant reductions in the subjects' systolic blood pressure and diastolic blood pressure were observed in both groups (p < 0.01 versus baseline). At 6 months a greater fall in blood pressure was observed in the sibutramine/verapamil sustained release/trandolapril group compared with the verapamil sustained release/trandolapril group (systolic blood pressure 21.9 +/- 8.1 versus 15.9 +/- 12.3 mmHg and diastolic blood pressure 15.7 +/- 8.1 versus 9.1 +/- 9.9 mmHg) but this was only significant (p = 0.03) for diastolic blood pressure. The subjects' heart rate did not change significantly in any group. No significant sibutramine-associated attenuation of blood pressure reduction was observed during the study. The sibutramine/verapamil sustained release/trandolapril treatment resulted in significantly greater improvement in the subjects' anthropometric variables, homeostasis model assessment and lipid profiles compared with verapamil sustained release/trandolapril administration. The subjects' small dense low-density lipoprotein cholesterol, high-sensitivity C-reactive protein and visfatin plasma levels were only measured in the sibutramine/verapamil sustained release/trandolapril group (all decreased by p < 0.05 versus baseline). CONCLUSIONS The sibutramine/verapamil sustained release/trandolapril combination in obese hypertensive patients significantly reduced their blood pressure and improved their anthropometric and metabolic variables without affecting the heart rate.
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Affiliation(s)
- E Nakou
- University of Ioannina, Department of Internal Medicine, School of Medicine, 45 110 Ioannina, Greece.
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Sood MM, Pauly RP, Rigatto C, Komenda P. Left ventricular dysfunction in the haemodialysis population. NDT Plus 2008; 1:199-205. [PMID: 25983883 PMCID: PMC4421219 DOI: 10.1093/ndtplus/sfn074] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 05/29/2008] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease in the haemodialysis population continues to contribute to mortality and morbidity. Disorders of left ventricular geometry and function are highly prevalent and lead to increased mortality in this highly vulnerable population. Left ventricular dysfunction (LVDys), often as a result of hypertension, ischaemic cardiac disease or dilated cardiomyopathy, has not been uniformly defined in the literature making diagnosis and therapy problematic. Although routinely available, screening by echocardiography is critically volume dependent and prone to underestimation in left ventricular ejection fraction. Few randomized control trials are available to guide management with the majority of evidence requiring extrapolation from the non-dialysis population. Beyond medication, interventional cardiac procedures such as implantable cardiac defibrillator implantation and cardiac resynchronization therapy show promise. Conversion to alternative dialysis modalities such as peritoneal dialysis, short-daily or nocturnal dialysis have been attempted and are actively being explored.
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Affiliation(s)
- Manish M. Sood
- St Boniface General Hospital and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert P. Pauly
- Edmonton General Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Claudio Rigatto
- St Boniface General Hospital and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- St Boniface General Hospital and the University of Manitoba, Winnipeg, Manitoba, Canada
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55
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Fang W, Yang X, Bargman JM, Oreopoulos DG. Association between Pulse Pressure and Mortality in Patients Undergoing Peritoneal Dialysis. Perit Dial Int 2008. [DOI: 10.1177/089686080902900210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Pulse pressure has been shown to be associated with adverse outcomes in the general population and in patients on hemodialysis (HD). However, the significance of pulse pressure has not been studied in peritoneal dialysis (PD) patients. This study examined the association between pulse pressure and mortality in patients undergoing chronic PD. Methods All patients aged 18 years or older that commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network, Toronto, were included. The association between pulse pressure and mortality was assessed using the Cox proportional hazards model. Results A total of 306 patients were included in the study. Mean pulse pressure of the study cohort was 56.8 ± 17.8 mmHg. Age and diabetes were significant predictors of elevated pulse pressure ( p < 0.001). After adjusting for the level of systolic blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modeling showed a direct and consistent association between pulse pressure and death risk. Each increment of 1 mmHg in pulse pressure was associated with a 2.7% increased hazard of all-cause death [95% confidence interval (CI) 1.001 – 1.054, p = 0.039] and a 4.1% increase in risk for cardiovascular mortality (hazard ratio 1.041, 95% CI 1.003 – 1.081; p = 0.035). Conclusion Elevated pulse pressure is associated with an increased risk of all-cause and cardiovascular death in patients on PD. Recognition of this characteristic as an important predictor of mortality suggests that one goal of antihypertensive therapy in PD patients should be to decrease elevated pulse pressure.
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Affiliation(s)
- Wei Fang
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xiao Yang
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Joanne M. Bargman
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Dimitrios G. Oreopoulos
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Agarwal R, Light RP. Arterial stiffness and interdialytic weight gain influence ambulatory blood pressure patterns in hemodialysis patients. Am J Physiol Renal Physiol 2007; 294:F303-8. [PMID: 18160623 DOI: 10.1152/ajprenal.00575.2007] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Besides an overall increase in blood pressure, hemodialysis patients have marked disturbance in interdialytic ambulatory blood pressure pattern that is characterized by blunted circadian amplitude and a steady rise in blood pressure between dialysis treatments. The pathophysiology of this abnormal blood pressure profile is poorly understood. We hypothesized that the circadian amplitude, the interdialytic increase (linear trend), and the average level of blood pressure (the intercept) are related to the extent of arterial stiffening and the degree of accumulation of salt and water between dialysis treatments. Using a generalized cosinor model, we simultaneously compared the impact of interdialytic weight gain and echo-Doppler-measured aortic pulse wave velocity on the mean level of blood pressure, linear changes over the interdialytic interval, and oscillatory changes in blood pressure. In a cross-sectional analysis of 11,833 blood pressure measurements from 125 long-term hemodialysis patients, we found that aortic pulse wave velocity and interdialytic weight gain had a substantial impact on interdialytic ambulatory blood pressure level, trends, and rhythms. Arterial stiffness was associated with an overall increase in the level (intercept) of systolic, diastolic, and pulse pressure. Interdialytic weight gain, on the other hand, was associated with interdialytic increase (linear trend) in blood pressure. The circadian amplitude was blunted by increments in either arterial stiffness or interdialytic weight gain. Since patterns of ambulatory arterial blood pressure are related to cardiovascular risk factors such as interdialytic weight gain and increased arterial stiffness, the pattern of ambulatory blood pressure recordings may also be of prognostic significance in hemodialysis patients.
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Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA.
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Othmane TEH, Bakonyi G, Egresits J, Fekete BC, Fodor E, Jarai Z, Jekkel C, Nemcsik J, Szabo A, Szabo T, Kiss I, Tisler A. Effect of sevelamer on aortic pulse wave velocity in patients on hemodialysis: a prospective observational study. Hemodial Int 2007; 11 Suppl 3:S13-21. [PMID: 17897105 DOI: 10.1111/j.1542-4758.2007.00224.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aortic stiffening and aortic calcification are risk factors for cardiovascular events in hemodialysis (HD) patients, and these 2 risk factors are interrelated. Sevelamer decreases aortic calcification but its effect on aortic stiffness has not been investigated previously. Thirteen HD patients commencing sevelamer treatment and 13 matched controls were followed for 11 months. Aortic pulse wave velocity (PWV), augmentation index (AIx), and levels of inhibitors of vascular calcification (fetuin-A, matrix-GLA-protein, osteoprotegerin/RANKL) were measured at baseline and at the end of follow-up, and the differences between the groups were compared. Determinants of the changes in PWV during follow-up were assessed by multivariate linear regression. At baseline, PWV was 9.93 (2.10) m/s in sevelamer-treated patients and 9.20 (2.84) m/s in control patients (p=0.464). By the end of follow-up, PWV decreased by 0.83 (2.3) m/s in sevelamer-treated patients while it increased by 0.93 (1.88) m/s in controls (p=0.042). The direction of changes in AIx were similar, but not statistically significant. There were no significant differences in the levels of inhibitors of calcification either at baseline or during follow-up. In multivariate linear regression sevelamer treatment, diabetes, heart rate, and C-reactive protein were related to the change in PWV. These data suggest that sevelamer treatment is associated with an improvement in aortic stiffness in HD patients, but it does not seem to affect serum levels of inhibitors of vascular calcification.
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Affiliation(s)
- Taha El Hadj Othmane
- 1st Department of Medicine, Semmelweis University, 2/a Korányi S, Budapest, Hungary
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Kaneshiro Y, Ichihara A, Sakoda M, Kurauchi A, Takemitsu T, Itoh H. Cilnidipine and Telmisartan Similarly Improves Vascular Damage in Hypertensive Patients. Clin Med Cardiol 2007. [DOI: 10.4137/cmc.s353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study was designed to compare the effects of 12-month blood pressure (BP) control using cilnidipine and telmisartan on vascular damage in untreated hypertensive patients. One hundred patients were randomly assigned to either a cilnidipine group or a telmisartan group. The extent of vascular damage was assessed before and after treatment by measuring urinary albumin excretion (UAE), pulse wave velocity (PWV), and intima-media thickness (IMT) of the carotid arteries in each patient. Both drugs similarly decreased BP without altering plasma markers for oxidative stress or inflammation. Both UAE and PWV were significantly improved in both groups, but IMT was significantly reduced only in the cilnidipine group. Multiple regression analyses suggested that the UAE may have decreased as a result of a reduction in intraglomerular pressure caused by telmisartan or by efferent arteriolar dilation caused by cilnidipine. In addition, the PWV may have decreased as a result of the improvement in lipid metabolism caused by telmisartan or the reduction in plasma levels of aldosterone caused by cilnidipine. However, the analyses could not identify any definitive causal relationships or suggest the mechanism responsible for the improvement in IMT caused by cilnidipine. Thus, telmisartan and cilnidipine have unique properties for inhibiting vascular complications.
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Affiliation(s)
- Yuki Kaneshiro
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Atsuhiro Ichihara
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mariyo Sakoda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Asako Kurauchi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tomoko Takemitsu
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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Agarwal R. Antihypertensive agents and arterial stiffness: relevance to reducing cardiovascular risk in the chronic kidney disease patient. Curr Opin Nephrol Hypertens 2007; 16:409-15. [PMID: 17693754 DOI: 10.1097/mnh.0b013e3282063b86] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Arterial stiffness is a sign of diffuse adventitial macrovascular disease. The purpose of the present review is to discuss, in patients with chronic kidney disease, the pathophysiology of increased arterial stiffness, the role of antihypertensive therapy on reduction of arterial stiffness, and the clinical ways by which the prognostication of cardiovascular disease in patients with chronic kidney disease can be refined using arterial stiffness monitoring. RECENT FINDINGS Arterial stiffness is increased with increasing prevalence of traditional cardiovascular risk factors. In patients with chronic kidney disease some unique factors further increase the risk of arterial stiffness, and include volume overload, activation of the renin-angiotensin system, anemia, and dysregulated mineral metabolism. Arterial stiffness is increased even in patients with early-stage chronic kidney disease. Blood pressure reduction when accompanied by a reduction in arterial stiffness is associated with improved prognosis. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can preferentially improve arterial stiffness, which may be an additional mechanism of cardiovascular protection with these agents. SUMMARY The impact of improvement in arterial stiffness with antihypertensive agents on cardiovascular outcomes needs well designed clinical trials.
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Affiliation(s)
- Rajiv Agarwal
- Indiana University School of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.
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Foley RN, Agarwal R. CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Hypertension Is Harmful to Dialysis Patients and Should Be Controlled. Semin Dial 2007; 20:518-22. [DOI: 10.1111/j.1525-139x.2007.00337.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gusbeth-Tatomir P, Covic A. Causes and consequences of increased arterial stiffness in chronic kidney disease patients. Kidney Blood Press Res 2007; 30:97-107. [PMID: 17374960 DOI: 10.1159/000100905] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 02/02/2007] [Indexed: 02/01/2023] Open
Abstract
Cardiovascular (CV) morbidity and mortality is greatly enhanced in patients with chronic kidney disease, compared to the non-renal population. One key element of this high CV burden appears to be arterial stiffness, as an expression of premature vascular aging. Increased arterial stiffness in renal patients may be a consequence of vascular calcification, chronic volume overload, inflammation, endothelial dysfunction, oxidative stress and several other factors. The authors review briefly the main pathophysiological mechanisms leading to reduced arterial compliance. Increased arterial stiffness has significant clinical consequences: isolated systolic hypertension, left ventricular hypertrophy (and failure), and reduced myocardial perfusion. Better knowledge of the mechanisms of arterial functional and morphologic alteration may help in developing more refined therapeutic strategies aimed to reduce the high CV burden in chronic kidney disease. The potential therapeutic interventions - mainly the use of certain antihypertensive drugs and reduction of vascular calcification - are finally discussed.
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Affiliation(s)
- Paul Gusbeth-Tatomir
- Dialysis and Renal Transplantation Center, Parhon University Hospital, Iasi, Romania
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Ichihara A, Kaneshiro Y, Sakoda M, Takemitsu T, Itoh H. Add-on Amlodipine Improves Arterial Function and Structure in Hypertensive Patients Treated With an Angiotensin Receptor Blocker. J Cardiovasc Pharmacol 2007; 49:161-6. [PMID: 17414228 DOI: 10.1097/fjc.0b013e31803104e5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study was designed to determine whether adding amlodipine further improved functional and structural cardiovascular damage in hypertensive patients whose blood pressure was already well controlled with an angiotensin II type 1 receptor blocker (ARB). The cardiothoracic ratio on chest radiographs, level of urinary albumin excretion, pulse wave velocity (PWV), intima-media thickness (IMT) of the carotid arteries, and 24 hour ambulatory blood pressure (BP) were evaluated before and 12 months after the start of add-on of amlodipine or placebo in 50 hypertensive patients being treated with an ARB. The add-on amlodipine therapy significantly improved the PWV from 1689 +/- 61 to 1447 +/- 47 cm/s and the IMT from 0.88 +/- 0.08 to 0.75 +/- 0.06 mm in the hypertensive patients treated with an ARB without altering their mean 24 hour ambulatory BP values, but did not alter the cardiothoracic ratio or urinary albumin excretion. Amlodipine also significantly decreased the variability of ambulatory BP, but the decrease did not significantly contribute to the changes in PWV or IMT. Thus, the add-on low-dose amlodipine therapy had benefits in terms of the vascular function and vascular structure of hypertensive patients treated with an ARB that were independent of its depressor effects. The antiatherogenic pleiotropic properties of amlodipine have a preventive effect on the progression of arterial stiffness in hypertensive patients treated with an ARB.
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Affiliation(s)
- Atsuhiro Ichihara
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
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63
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Furuya R, Odamaki M, Kumagai H, Hishida A. Impact of Angiotensin II Receptor Blocker on Plasma Levels of Adiponectin and Advanced Oxidation Protein Products in Peritoneal Dialysis Patients. Blood Purif 2006; 24:445-50. [PMID: 16940715 DOI: 10.1159/000095361] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 06/13/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND Oxidative stress and adipocytokines are reported to contribute to the pathogenesis of atherosclerosis. Though the inhibition of the renin-angiotensin system is known to have beneficial effects on atherosclerosis, the exact mechanisms for this remain to be clarified. The aim of this study was to determine the effects of angiotensin II receptor blockers (ARB) on the oxidative stress and adipocytokines in peritoneal dialysis patients. METHODS Candesartan (8 mg/day), an ARB, was administered for 3 months to 8 nondiabetic patients on peritoneal dialysis. Plasma levels of advanced oxidation protein products (AOPP) and adiponectin were measured before and 3 months after candesartan administration, and 3 months after discontinuation. RESULTS Plasma AOPP level decreased from 377.5 to 305.6 micromol/l (p < 0.05) following the administration of candesartan and returned to 394.6 micromol/l (p < 0.05) by 3 months after the discontinuation of the drug. Plasma adiponectin level increased from 12.5 to 18.8 microg/ml (p < 0.05) by candesartan and decreased again to 14.4 microg/ml (p < 0.05) after discontinuation. There was a significant inverse relationship between changes in plasma level of adiponectin and AOPP (r = - 0.888, p < 0.01). CONCLUSION Candesartan increases plasma adiponectin level in association with the reduction of oxidative stress in peritoneal dialysis patients. Candesartan may be useful in preventing atherosclerosis in peritoneal dialysis patients.
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Affiliation(s)
- Ryuichi Furuya
- Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
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Ichihara A, Kaneshiro Y, Takemitsu T, Sakoda M, Itoh H. Benefits of candesartan on arterial and renal damage of non-diabetic hypertensive patients treated with calcium channel blockers. Am J Nephrol 2006; 26:462-8. [PMID: 17063001 DOI: 10.1159/000096581] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 09/19/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Although long-term, intensive blood pressure (BP) control with calcium channel blockers (CCBs) reduced arterial stiffness and renal damage of hypertensive patients, combination therapy with antihypertensive drugs is frequently needed to maintain the intensive BP control. The present study was conducted to examine add-on benefits of candesartan therapy on hypertensive patients treated with CCBs for at least 12 months. METHODS Pulse wave velocity (PWV), urinary albumin excretion (UAE), intima-media thickness (IMT) of the carotid arteries, and 24-hour ambulatory BP were determined in 50 non-diabetic hypertensive patients treated with CCBs before and 12 months after the start of therapy with candesartan or placebo. RESULTS Candesartan significantly decreased clinic BP and tended to decrease ambulatory BP, but the decreases were similar to those in the placebo group except nocturnal BP decrease, which was significantly enhanced by candesartan. Add-on candesartan significantly decreased PWV and UAE compared to placebo, but IMT was unchanged with candesartan or placebo. The decrease in clinic BP or nocturnal BP decrease did not contribute to the improvement of PWV or UAE. CONCLUSION Add-on candesartan functionally improved the stiffened arteries of hypertensive patients treated with CCBs by the end of 12 months of treatment independently of its effects on BPs.
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Affiliation(s)
- Atsuhiro Ichihara
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Ichihara A, Kaneshiro Y, Takemitsu T, Sakoda M, Hayashi M. Ambulatory blood pressure variability and brachial-ankle pulse wave velocity in untreated hypertensive patients. J Hum Hypertens 2006; 20:529-36. [PMID: 16598288 DOI: 10.1038/sj.jhh.1002023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 03/01/2006] [Accepted: 03/02/2006] [Indexed: 11/09/2022]
Abstract
Blood pressure (BP) variability is estimated as the standard deviation of 24-h ambulatory BP. The present study was performed to determine the effect of the mean 24-h ambulatory BP values and standard deviations on arterial wall stiffness assessed by brachial-ankle pulse wave velocity (baPWV). Brachial-ankle pulse wave velocity, carotid intima-media thickness (IMT), urinary albumin excretion (UAE) and 24-h ambulatory BP were measured before the start of antihypertensive therapy in 203 newly diagnosed hypertensive patients (53.3+/-0.7 years old; clinic systolic/diastolic BP: 154+/-1/98+/-1 mm Hg), and univariate and multivariate regression analyses of these clinical and biological parameters were performed. Univariate regression analyses revealed a significant association between mean baPWV values and the standard deviations of ambulatory systolic/diastolic BP. Mean ambulatory systolic/diastolic BP values were also associated with UAE, and the standard deviations of ambulatory systolic BP were associated with maximum carotid IMT. Quintile analyses showed that patients with a mean 24-h ambulatory mean BP value and standard deviation below 110 and 20 mm Hg, respectively, had the lowest baPWV. Moreover, the multivariate regression analyses confirmed a significant correlation between baPWV and the standard deviation of 24-h ambulatory systolic BP. In conclusion, untreated hypertensive patients with a higher 24-h ambulatory systolic BP variability had stiffer arterial walls. Ambulatory systolic BP variability may be involved in stiffening of the arteries of hypertensive patients.
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Affiliation(s)
- A Ichihara
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
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Ichihara A, Kaneshiro Y, Takemitsu T, Sakoda M. Effects of amlodipine and valsartan on vascular damage and ambulatory blood pressure in untreated hypertensive patients. J Hum Hypertens 2006; 20:787-94. [PMID: 16810279 DOI: 10.1038/sj.jhh.1002067] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study was performed to compare the long-term effects of 24-h ambulatory blood pressure (BP) control with amlodipine versus valsartan on vascular damage in untreated hypertensive patients. Amlodipine and valsartan have benefits on cardiovascular mortality and morbidity in hypertensive patients. Although ambulatory BP is associated with severity of target-organ damage in hypertensive patients, beneficial effects of ambulatory BP control with amlodipine versus valsartan on vascular damage have not been compared. Pulse wave velocity (PWV), intima-media thickness (IMT) of the carotid arteries, urinary albumin excretion (UAE) and 24-h ambulatory BP were determined in 100 untreated hypertensive patients before and 12 months after the start of antihypertensive therapy with amlodipine or valsartan. Amlodipine and valsartan decreased ambulatory BP similarly, but the variability of 24-h and daytime ambulatory systolic BP was significantly reduced by amlodipine but not by valsartan. The reduced variability of ambulatory systolic BP caused by amlodipine significantly contributed to the improvement of PWV, although both drugs decreased PWV similarly. Carotid IMT was unaffected by treatment with either drug. Valsartan significantly decreased UAE independently of its depressor effect, but amlodipine had no effect on UAE. These results suggest that the 24-h control of ambulatory BP with amlodipine had functionally improved the stiffened arteries of hypertensive patients by the end of 12 months of treatment, in part through reducing BP variability, whereas ambulatory BP control with valsartan decreased the arterial stiffness to the same degree as amlodipine without affecting BP variability maybe through some pleiotropic effects.
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Affiliation(s)
- A Ichihara
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
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Effect of Losartan and Amlodipine on Left Ventricular Diastolic Function in Patients With Mild-to-Moderate Hypertension (J-ELAN) Rationale and Design. Circ J 2006; 70:124-8. [PMID: 16377936 DOI: 10.1253/circj.70.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypertension is a major underlying disease that may cause left ventricular (LV) diastolic dysfunction, even without LV systolic dysfunction, and antihypertensive drugs could affect LV diastolic function. METHODS AND RESULTS The Effect of Losartan and Amlodipine on Left Ventricular Diastolic Function in Patients With Mild-to-Moderate Hypertension (J-ELAN) study is a multicenter, prospective, randomized trial designed to assess the effects of losartan and amlodipine on LV diastolic function in hypertensive patients with LV diastolic dysfunction in the absence of systolic dysfunction. A total of 300 patients (150 patients in each group) will be enrolled. In addition to Doppler echocardiographic indices of LV diastolic function, changes in LV structure and atherosclerosis of the carotid arteries will be serially assessed. The maximum follow-up period is 18 months. CONCLUSIONS This study will provide the characteristic differences in the effects of amlodipine and losartan on LV diastolic dysfunction in hypertensive patients.
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Banerjee D, Brincat S, Gregson H, Contreras G, Streather C, Oliveira D, Nelson S. Pulse pressure and inhibition of renin–angiotensin system in chronic kidney disease. Nephrol Dial Transplant 2005; 21:975-8. [PMID: 16384830 DOI: 10.1093/ndt/gfi345] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated pulse pressure (PP) is an indicator of poor outcome in hypertensives in the general population and on haemodialysis. The prognostic value of PP in pre-dialysis patients with chronic kidney disease (CKD) stages 4/5 and its interaction with renin-angiotensin system (RAS) inhibitors is unknown. METHODS This retrospective study of 349 patients from the pre-dialysis clinic analysed the effect association of PP and RAS inhibition on adverse outcomes in CKD stages 4/5. Primary endpoints were a composite of death or dialysis. RESULTS At baseline, 349 patients (63% males, 34% diabetics) were aged 60+/-0.8 years (mean+/-SEM) with systolic blood pressure (SBP) 149+/-1.3 mmHg, diastolic BP (DBP) 83+/-0.7 mmHg, PP 66+/- 1.0 mmHg, creatinine 442+/-16 micromol/l and haemoglobin 10.7+/-0.1 g/dl. Patients were followed up for 297+/-19 days and 93% took one to seven (2.45+/-0.07) antihypertensives. At presentation, the adverse outcome group had higher SBP (151+/-1.5 vs 145+/-2.4 mmHg; P<0.05), proportion of diabetes (39% vs 23%; P<0.05) and creatinine (478+/-22 vs 354+/-11 micromol/l; P<0.05), but lower haemoglobin (10.6+/-0.1 vs 11.2+/-0.2 g/dl; P<0.05). PP increased with age (r(2): 0.4; P<0.0001). PP >80 mmHg was associated with adverse outcome (Kaplan-Meier survival analysis, log-rank test P<0.05). In a model of proportional hazards regression, adjusted for age, baseline creatinine, diabetes and haemoglobin, elevated PP was associated with poorer outcome (hazards ratio: 1.09; 95% confidence interval: 1.01-1.18; P<0.05) and angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker use was beneficial (hazards ratio: 0.73; 95% confidence interval: 0.53-0.99; P<0.05). CONCLUSIONS The study demonstrates that elevated PP indicates high risk of death or dialysis and the benefit of blockade of the RAS is independent of the baseline PP in patients with CKD stages 4/5.
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Affiliation(s)
- Debasish Banerjee
- Department of Renal Medicine and Transplantation, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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