Combination Therapy of Calcium Channel Blocker and Angiotensin II Receptor Blocker Reduces Augmentation Index in Hypertensive Patients

Doi, Masayuki; Miyoshi, Toru; Hirohata, Satoshi; Kamikawa, Shigeshi; Ogawa, Hiroyasu; Ninomiya, Yoshifumi; Kusachi, Shozo; Usui, Shinichi; Kaji, Youko; Sakane, Kosuke

doi:10.1097/maj.0b013e3181d658c4

Cited by 23 publications

(18 citation statements)

References 36 publications

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“…We have shown that ARBs decrease the AI [7, 8] but there has not been any prior study focusing on the effect of OLM on AI. In the present study, OLM produced a reduction in the AI whereas AZL has been previously shown to cause a significant reduction in AI in combination with ARBs [26]. This was confirmed in the present study indicating that combination therapy results in a reduction in AI.…”

Section: Discussionsupporting

confidence: 90%

Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial)

Kinouchi

Ichihara

Bokuda

et al. 2011

International Journal of Hypertension

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Background/Aims. Arterial stiffness is an independent risk factor for cardiovascular morbidity and mortality. This study was conducted to determine the effect of olmesartan (OLM) and azelnidipine (AZL) on arterial stiffness using the cardio-ankle vascular index (CAVI), which is a novel blood pressure (BP)-independent marker for arterial stiffness in hypertensive patients. Methods. Fifty-two consecutive hypertensive patients were randomly assigned either to a group treated with OLM monotherapy or to a group treated with OLM and AZL combination therapy. Clinical and biological parameters were measured before and 12 months after the start of this study. Results. Both therapies significantly and similarly reduced BP, augmentation index, and plasma aldosterone levels. The combination therapy significantly decreased CAVI and serum low-density lipoprotein (LDL-C) levels and these reductions were significantly greater than those produced with monotherapy. No significant differences in metabolic parameters were observed between the two therapies. Conclusion. The combination therapy with OLM and AZL had beneficial effects on arterial stiffness assessed by CAVI, LDL-C, and metabolism, despite the similar BP reduction, compared with OLM monotherapy. Since these markers are known to influence the future risk of cardiovascular events, combination therapy with OLM and AZL could be a useful choice for treating hypertensive patients.

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Section: Discussionsupporting

confidence: 90%

Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial)

Kinouchi

Ichihara

Bokuda

et al. 2011

International Journal of Hypertension

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“…In a study comparing the CCB azelnidipine or the thiazide diuretic trichlormethiazide added to an ARB, the ARB plus azelnidipine combination produced significantly greater reductions in hsCRP than the ARB plus thiazide combination; this reduction mirrored the BP-lowering effects [110]. Similar data were shown in a 4-month crossover study comparing olmesartan medoxomil plus azelnidipine or trichlormethiazide [111] [112].…”

Section: Hscrpsupporting

confidence: 66%

The Effects of Antihypertensive Agents in Metabolic Syndrome – Benefits Beyond Blood Pressure Control

Merchant¹,

Khan²

2012

Insulin Resistance

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“…[6][7][8] Our previous study showed the effect of a combination of an ARB and a CCB on AI was greater than that of an ARB and a diuretic. 9 In this study, dual RAS blockade with a direct renin inhibitor and an ARB was not able to show greater decrease in AI and central BP more than a combination of a diuretic and an ARB. Aliskiren suppresses the stimulation of the angiotensin II type 2 receptor, rather than blocking it like an ARB, 18 and downregulates the ACE2/angiotensin-(1-7)/Mas receptor axis by inhibiting the upstream component of RAS.…”

Section: Discussioncontrasting

confidence: 53%

“…The mean of two readings was used to determine systolic BP, diastolic BP, mean arterial pressure and pulse pressure. 9 Next, the radial pulse wave was determined at the wrist using applanation tonometry with a high-fidelity micromanometer (HEM-9000AI; Omron Healthcare, Kyoto, Japan), as previously described. 12 13 The AI of the radial pulse was calculated as the difference between the first systolic peak and the second systolic peak (reflection wave) of the pulse waveform, expressed as a percentage of the second peak relative to the first peak.…”

Section: End Pointsmentioning

confidence: 99%

Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study

Miyoshi

Murakami²,

Sakuragi

et al. 2017

Open Heart

Self Cite

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BackgroundThe effects of antihypertensive drug combination therapy on central blood pressure (BP) and augmentation index (AI) have not been fully elucidated. We investigated the effects of the direct renin inhibitor, aliskiren, or a diuretic added to an angiotensin II receptor blocker on AI in patients with essential hypertension.MethodsA 24-week, prospective, multicentre, randomised, open-label study enrolled 103 patients already treated with valsartan. Participants were randomly allocated to receive either valsartan with aliskiren (V+A), or valsartan with trichlormethiazide (V+T). The primary outcome was the change in AI derived from radial artery tonometry. Secondary outcome measures included systolic and diastolic BP, cardio-ankle vascular index (CAVI, which reflects arterial stiffness) and urinary 8-hydroxydeoxyguanosine concentration.ResultsAfter 24 weeks, systolic and diastolic BP were significantly reduced in both groups to a broadly comparable extent. There was no significant difference in AI at the end of the study between the V+A group and the V+T group (between-group difference: −2.3%, 95% CI −6.9% to 2.2%, p=0.31). Central BP at the end of the study also did not differ between the two groups (p=0.62). There was no significant difference in the CAVI between the groups at the end of the study. Urinary 8-hydroxydeoxyguanosine concentration was significantly lower in the V+A group than in the V+T group (p<0.01), suggesting that V+A attenuated oxidative stress more than V+T.ConclusionThe combination of valsartan and aliskiren had an effect on AI comparable with that of the combination of valsartan and trichlormethiazide.UMIN Clinical Trial Registration numberUMIN000005726.

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Combination Therapy of Calcium Channel Blocker and Angiotensin II Receptor Blocker Reduces Augmentation Index in Hypertensive Patients

Cited by 23 publications

References 36 publications

Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial)

Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial)

The Effects of Antihypertensive Agents in Metabolic Syndrome – Benefits Beyond Blood Pressure Control

Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study

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