Arterial compliance changes in diabetic normotensive patients after angiotensin-converting enzyme inhibition therapy

Manolis, Athanasios; Iraklianou, Stella; Pittaras, Andreas; Zairis, Michael N.; Tsioufis, Κonstantinos; Psaltiras, G.; Psomali, Demetra; Foussas, Stefanos; Gavras, Irène; Gavras, Haralambos

doi:10.1016/j.amjhyper.2004.08.014

Cited by 32 publications

(13 citation statements)

References 27 publications

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“…Within the Type 2 DM cohort, a significant number were on antihypertensive and lipid-lowering agents, which may affect both arterial stiffness and diastolic parameters [29,30]. However, these medications are known to reduce arterial stiffness and would therefore have minimized the difference between the two groups.…”

Section: Limitations Of the Studymentioning

confidence: 97%

Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes

Soldatos¹,

Jandeleit-Dahm²,

Thomson

et al. 2010

Diabetic Medicine

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Patients with Type 2 DM on standard medication showed preferential stiffening of the large central arteries. However, carotid augmentation index was not different between the two groups and is therefore not a reliable indicator of large artery stiffening in this patient group. Diastolic dysfunction, present in a significant proportion of this population with Type 2 DM, was closely associated with arterial stiffening, suggesting a common aetiology.

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Section: Limitations Of the Studymentioning

confidence: 97%

Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes

Soldatos¹,

Jandeleit-Dahm²,

Thomson

et al. 2010

Diabetic Medicine

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“…Aside from effects of RAAS and SNS activation on vascular function, arterial stiffness increases under the influence of ambient hyperglycaemia and can be improved through tight glycemic control [9-11]. Intensification of glycemic control in both T1D and T2D reduces arterial stiffness, which may contribute to improved blood pressure control and a decreased risk of cardiovascular complications [12-14].…”

Section: Introductionmentioning

confidence: 99%

The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus

Cherney

Perkins

Soleymanlou

et al. 2014

Cardiovasc Diabetol

430

307

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BackgroundIndividuals with type 1 diabetes mellitus are at high risk for the development of hypertension, contributing to cardiovascular complications. Hyperglycaemia-mediated neurohormonal activation increases arterial stiffness, and is an important contributing factor for hypertension. Since the sodium glucose cotransport-2 (SGLT2) inhibitor empagliflozin lowers blood pressure and HbA1c in type 1 diabetes mellitus, we hypothesized that this agent would also reduce arterial stiffness and markers of sympathetic nervous system activity.MethodsBlood pressure, arterial stiffness, heart rate variability (HRV) and circulating adrenergic mediators were measured during clamped euglycaemia (blood glucose 4–6 mmol/L) and hyperglycaemia (blood glucose 9–11 mmol/L) in 40 normotensive type 1 diabetes mellitus patients. Studies were repeated after 8 weeks of empagliflozin (25 mg once daily).ResultsIn response to empagliflozin during clamped euglycaemia, systolic blood pressure (111 ± 9 to 109 ± 9 mmHg, p = 0.02) and augmentation indices at the radial (-52% ± 16 to -57% ± 17, p = 0.0001), carotid (+1.3 ± 1 7.0 to -5.7 ± 17.0%, p < 0.0001) and aortic positions (+0.1 ± 13.4 to -6.2 ± 14.3%, p < 0.0001) declined. Similar effects on arterial stiffness were observed during clamped hyperglycaemia without changing blood pressure under this condition. Carotid-radial pulse wave velocity decreased significantly under both glycemic conditions (p ≤ 0.0001), while declines in carotid-femoral pulse wave velocity were only significant during clamped hyperglycaemia (5.7 ± 1.1 to 5.2 ± 0.9 m/s, p = 0.0017). HRV, plasma noradrenalin and adrenaline remained unchanged under both clamped euglycemic and hyperglycemic conditions.ConclusionsEmpagliflozin is associated with a decline in arterial stiffness in young type 1 diabetes mellitus subjects. The underlying mechanisms may relate to pleiotropic actions of SGLT2 inhibition, including glucose lowering, antihypertensive and weight reduction effects.Trial registrationClinical trial registration: NCT01392560

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“…Although the treatments showed a significant change in preclinical vasculopathy from the baseline, but could not find any difference in comparison to placebo. The main reason why diabetic patients failed to show any changes may be due to shorter duration of intervention3,8,10 and/or lower dose of the drugs 14. The much-developed vasculopathy in established diabetes may need intervention for a longer period of time7,15 and/or the use of higher doses of rosiglitazone (8 mg)16 and ramipril (10 mg) 7,15…”

Section: Discussionmentioning

confidence: 99%

“…Previous short-term studies (12 week to 6 months) on diabetes8,10 and hypertensive patients22,23 investigated effectiveness of ACE inhibitors on arterial stiffness could not definitively establish therapeutic efficacy. In a recent study, Kaiser et al8 compared the effects of a β-blocker (nebivolol) with an ACE inhibitor (enalapril) on parameters of insulin sensitivity, peripheral blood flow and arterial stiffness in T2DM patients assessing PWV and AI using SphygmoCor.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment goals for T2DM specify targets for glycemia and other cardiometabolic risk factors, eg, hypertension and dyslipidemia. In recent years, special interest has been developed in the use of thiazolidinediones (TZDs) (eg, rosiglitazone, 3,4 piolitazone5,6) and angiotensin converting enzyme (ACE) inhibitors (eg, ramipril,7 enalapril,8,9 perindopril10) to treat diabetic macrovasculopathy. To date, a few studies had been conducted on T2DM to investigate the pharmacological actions of rosiglitazone3,4 and ramipril7 on arterial stiffness.…”

mentioning

confidence: 99%

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Effect of rosiglitazone and ramipril on macrovasculopathy in patients with type 2 diabetes: needs longer  treatment and/or higher doses?

Rahman

Ismail²,

Ismail³

et al. 2010

CPAA

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IntroductionThe aim of the study is to investigate whether standard doses of rosiglitazone (4 mg/daily) and ramipril (5 mg/daily) can reverse pre-clinical macrovasculopathy in newly diagnosed never treated type 2 diabetes (T2DM) patients.MethodsIn this randomized, double-blind, placebo-controlled study, 33 T2DM patients were randomized to rosiglitazone (4 mg/daily) or ramipril (5 mg/daily) or placebo for 1 year. Hemodynamic variables were measured at 3 treatment phases and pulse wave velocity (PWV) and augmentation index (AI) were measured throughout the treatment period.ResultIn diabetic patients, PWV (P = 0.037) and AI (P = 0.005) with ramipril and AI (P < 0.001) with rosiglitazone were significantly reduced during overall treatment period from the baseline; however, these differences were not significant in comparison to placebo.Discussion and conclusionThe present study showed that treatment with standard doses of rosiglitazone and ramipril are not adequate to reverse pre-clinical vasculopathy in T2DM. The lack of benefit in newly diagnosed T2DM may be because of the relatively short-term intervention and/or the use of lower doses of rosiglitazone/ramipril. Further trials are needed for a longer period of time, possibly with higher doses, to show whether rosiglitazone/ramipril can reverse pre-clinical vasculopathy in T2DM (ClinicalTrials.gov number, NCT00489229).

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Arterial compliance changes in diabetic normotensive patients after angiotensin-converting enzyme inhibition therapy

Cited by 32 publications

References 27 publications

Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes

Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes

The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus

Effect of rosiglitazone and ramipril on macrovasculopathy in patients with type 2 diabetes: needs longer  treatment and/or higher doses?

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Arterial compliance changes in diabetic normotensive patients after angiotensin-converting enzyme inhibition therapy

Cited by 32 publications

References 27 publications

Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes

Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes

The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus

Effect of rosiglitazone and ramipril on macrovasculopathy in patients with type 2 diabetes: needs longer&nbsp; treatment and/or higher doses?

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Effect of rosiglitazone and ramipril on macrovasculopathy in patients with type 2 diabetes: needs longer treatment and/or higher doses?