Aggressive antihypertensive strategies based on hydrochlorothiazide, candesartan or lisinopril decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension

Man, Angélique M. E. de; Ittersum, Frans J. van; Schram, Miranda T.; Kamp, Otto; Dijk, R A J M van; IJzerman, Richard G.; Twisk, Jos W. R.; Brouwer, Catherine B.; Stehouwer, Coen D.A.

doi:10.1038/sj.jhh.1002025

Cited by 20 publications

(13 citation statements)

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“…24,25 In the present study, age, baseline SBP and pulse pressure were positively correlated to the effects of SBP reduction by thiazide treatment, suggesting the possible early presence of increased stiffness of large arteries even in a cohort of mainly middle-aged hypertensives. 26,27 Accordingly, thiazide diuretics either alone or in combination may have particular beneficial effects not only on elderly patients 28,29 but also on younger patients with increased arterial or aortic stiffness as that shown in the present study.…”

Section: Identification Of the Thiazide Responders C-c Huang Et Almentioning

confidence: 50%

Clinical predictors of the response to short-term thiazide treatment in nondiabetic essential hypertensives

Huang¹,

Leu²,

Wu³

et al. 2008

J Hum Hypertens

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Blood pressure (BP) response to diuretics is varied in hypertensive patients. This study aimed to identify the patients who may respond better or worse to thiazide diuretics. Nondiabetic patients with treated or untreated hypertension were evaluated if they did not take diuretics and their office systolic BP (SBP) 4140 mm Hg or diastolic BP (DBP) 490 mm Hg. Diet and life style modification were advised in addition to the concomitant medication, if there were, for 2 weeks. Additional hydrochlorothiazide 50 mg was given per day for another 2 weeks. Both office and 24-h ambulatory BP were checked. The changes of office SBP were used for the response to thiazide treatment. A total of 92 patients were enrolled. Compared with those in the quartile of worst response, patients in the quartile of best response were older with increased baseline SBP and pulse pressure (PP) and reduced heart rate. Reduced baseline awake, but not increased sleep DBP was associated with better response to thiazide. Besides, baseline age, SBP and PP were correlated to the response to thiazide treatment. Among these variables, increased baseline mean BP independently predicted the best and reduced SBP predicted the worst responders. Accordingly, patients with higher mean BP respond better to thiazide treatment no matter with or without concomitant medication. Patients with mainly diastolic hypertension with lower SBP responded poorly to thiazide treatment. The findings may help to individualized use of thiazide in nondiabetic hypertensives.

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Section: Identification Of the Thiazide Responders C-c Huang Et Almentioning

confidence: 50%

Clinical predictors of the response to short-term thiazide treatment in nondiabetic essential hypertensives

Huang¹,

Leu²,

Wu³

et al. 2008

J Hum Hypertens

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“…14,22,25,27,28,41,69,78,79,84,88,89,92 Apart from one study in which there was a greater reduction of left ventricular hypertrophy with an ARB, 89 there were no differences between ACE inhibitor and ARB groups. Only one study evaluated a DRI; it found similar effects between aliskiren and an ARB.…”

Section: Left Ventricular Mass or Functionmentioning

confidence: 99%

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

et al. 2011

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OBJECTIVES:A 2007 systematic review compared angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in patients with hypertension. Direct renin inhibitors (DRIs) have since been introduced, and significant new research has been published. We sought to update and expand the 2007 review. DATA SOURCES: We searched MEDLINE and EMBASE (through December 2010) and selected other sources for relevant English-language trials. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: We included studies that directly compared ACE inhibitors, ARBs, and/or DRIs in at least 20 total adults with essential hypertension; had at least 12 weeks of follow-up; and reported at least one outcome of interest. Ninety-seven (97) studies (36 new since 2007) directly comparing ACE inhibitors versus ARBs and three studies directly comparing DRIs to ACE inhibitor inhibitors or ARBs were included. STUDY APPRAISAL AND SYNTHESIS METHODS: A standard protocol was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality; and summarize the evidence. RESULTS: In spite of substantial new evidence, none of the conclusions from the 2007 review changed. The level of evidence remains high for equivalence between ACE inhibitors and ARBs for blood pressure lowering and use as single antihypertensive agents, as well as for superiority of ARBs for short-term adverse events (primarily cough). However, the new evidence was insufficient on long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, and differences in key patient subgroups. LIMITATIONS: Included studies were limited by followup duration, protocol heterogeneity, and infrequent reporting on patient subgroups. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Evidence does not support a meaningful difference between ACE inhibitors and ARBs for any outcome except medication side effects. Few, if any, of the questions that were not answered in the 2007 report have been addressed by the 36 new studies. Future research in this area should consider areas of uncertainty and be prioritized accordingly. CLINICAL CASEA 54-year-old woman with a history of hypertension is seen by her doctor for persistently elevated blood pressure in spite of adherence to hydrochlorothiazide 25 mg daily. She is overweight and has a strong family history of coronary artery disease. To control her blood pressure, she and her doctor discuss adding an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin II receptor blocker (ARB), or a direct renin inhibitor (DRI) to her regimen. She is primarily interested in avoiding the cardiovascular complications of hypertension, but does not want to take medication more than once a day, and she is concerned about side effects and the cost of her medication. What information is available to help guide her decision?Electronic supplementary material The online version of this article

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“…12 These findings in relation to the thiazide diuretics and the angiotensin II blockers are novel. [13][14][15] Thiazide diuretics have different pharmacologic properties that may affect arterial aging. Indeed, the increase in arterial stiffness with thiazide use might be linked by the calcium metabolism.…”

mentioning

confidence: 99%

“…[15][16][17][18][19][20][21] Although pathophysiologically very important, arterial stiffness is still a surrogate end point and what finally counts for the clinician (and for the patient) is the effect of treatment on cardiovascular morbidity and mortality (as proven in large randomized controlled trials). Therefore, there is still a need for data from prospective short term and long-term studies assessing the effects of the so-called 'cardiovascular protective drugs' on arterial aging and on clinical outcome data, thereby comparing results on the basis of central hemodynamic parameters with results based on peripheral measures.…”

mentioning

confidence: 99%

Cardiovascular prevention: relationships between arterial aging and chronic drug treatment

Backer

2011

J Hum Hypertens

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In hypertension, structural and functional properties of the arterial wall are altered, and morbidity and mortality associated with hypertension are related to the vascular damage affecting several organs.Going from central to peripheral arteries, the diameter and the composition of the vessel wall vary in important ways. In addition, the aorta and its main branches are highly sensitive to aging and changes in blood pressure while the more distal compartment is the major source of wave reflections and highly sensitive to vasoactive substances.Indeed, blood pressure propagation within the arterial tree is based on arterial stiffness, wave reflections and pulse pressure (PP). 1 Of note, arterial stiffness is an independent predictor for cardiovascular mortality and morbidity, and pulse wave velocity is currently accepted as the gold standard measure of arterial stiffness. [2][3][4] Early wave reflections, as evaluated by pulse wave analysis, are also an independent predictor of cardiovascular risk. 5 In the treatment of hypertension there is evidence by large randomized controlled trials and meta-analyses for a beneficial effect on hard endpoints (cardiovascular morbidity and mortality, stroke, kidney disease) for b-blockers, diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers. 6 In the first (but small) prospective randomised study, for example, Mackenzie et al. 7 investigated the effects of four major antihypertensive classes (atenolol, bendrofluazide, lercarnidipine, perindopril) on both central and peripheral blood pressures, PP amplification and aortic pulse wave velocity (PWV) in isolated systolic hypertension patients. They found that aortic PWV was not changed by any of the investigated drugs, and that despite similar reductions in peripheral systolic and pulse pressures with the four drugs, the changes in central pressure and augmentation index varied.Therapies combating arterial stiffness, reducing PP and reducing early wave reflections are believed to further reduce cardiovascular mortality. These treatments include exercise, nitrates, renin-angiotensin-aldosterone inhibitors, drugs acting on collagen cross-linking and vasopeptidase inhibitors. 8 Large scale, long term randomised controlled are necessary to prove that these agents effectively and safely diminish arterial stiffness and by this reduce cardiovascular morbidity and mortality.In the current issue of the Journal of Human Hypertension, Lieber et al. 9 report the results of a rather small cross-sectional analysis determining statistical associations between chronic drug treatment acting on cardiovascular prevention (antihypertensives, statins and oral antidiabetics and/or insulin) and age-induced changes in arterial stiffness and wave reflections. They conclude that calcium channel blockers and statins do not show any statistical association with PWV or wave reflection (augmentation index); that b-blockers are significantly associated with increased wave reflections and central PP; and that diuretics, angiotens...

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Aggressive antihypertensive strategies based on hydrochlorothiazide, candesartan or lisinopril decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension

Cited by 20 publications

References 47 publications

Clinical predictors of the response to short-term thiazide treatment in nondiabetic essential hypertensives

Clinical predictors of the response to short-term thiazide treatment in nondiabetic essential hypertensives

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

Cardiovascular prevention: relationships between arterial aging and chronic drug treatment

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