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

Omboni, Stefano

doi:10.21037/jtd.2016.05.32

Cited by 2 publications

(4 citation statements)

References 8 publications

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“…Finally, in a subgroup of 93 elderly hypertensive patients of the ZEUS study, treatment with zofenopril or irbesartan was associated with small reductions in central SBP and arterial stiffness indices (pulse wave velocity or PWV and augmentation index or AI), which were similar between the two study drugs at any time point of the study, including the first 6 weeks when all patients were treated with the lowest dose of zofenopril or irbesartan combined with the thiazide diuretic. Though such improvements were not striking as a result of the limited vascular impairments of the patients, they are relevant, because arterial stiffness represents a late manifestation of increase elastic arterial stiffness [ 21 ], and because they are consistent with those observed in previous randomized studies with the same classes of antihypertensive agents [ 22 – 24 ].…”

Section: Introductionsupporting

confidence: 69%

Efficacy of Zofenopril vs. Irbesartan in Combination with a Thiazide Diuretic in Hypertensive Patients with Multiple Risk Factors not Controlled by a Previous Monotherapy: A Review of the Double-Blind, Randomized “Z” Studies

et al. 2017

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Combinations between an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) and hydrochlorothiazide (HCTZ) are among the recommended treatments for hypertensive patients uncontrolled by monotherapy. Four randomized, double-blind, parallel group studies with a similar design, including 1469 hypertensive patients uncontrolled by a previous monotherapy and with ≥1 cardiovascular risk factor, compared the efficacy of a combination of a sulfhydryl ACE inhibitor (zofenopril at 30 or 60 mg) or an ARB (irbesartan at 150 or 300 mg) plus HCTZ 12.5 mg. The extent of blood pressure (BP)-lowering was assessed in the office and over 24 h. Pleiotropic features of the treatments were evaluated by studying their effect on systemic inflammation, organ damage, arterial stiffness, and metabolic biochemical parameters. Both treatments similarly reduced office and ambulatory BPs after 18–24 weeks. In the ZODIAC study a larger reduction in high sensitivity C reactive protein (hs-CRP) was observed under zofenopril (−0.52 vs. +0.97 mg/dL under irbesartan, p = 0.001), suggesting a potential protective effect against the development of atherosclerosis. In the ZENITH study the rate of carotid plaque regression was significantly larger under zofenopril (32% vs. 16%; p = 0.047). In the diabetic patients of the ZAMES study, no adverse effects of treatments on blood glucose and lipids as well as an improvement of renal function were observed. In patients with isolated systolic hypertension of the ZEUS study, a slight and similar improvement in renal function and small reductions in pulse wave velocity (PWV), augmentation index (AI), and central systolic BP were documented with both treatments. Thus, the fixed combination of zofenopril and HCTZ may have a relevant place in the treatment of high-risk or monotherapy-treated uncontrolled hypertensive patients requiring a more prompt, intensive, and sustained BP reduction, in line with the recommendations of current guidelines.

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Section: Introductionsupporting

confidence: 69%

Efficacy of Zofenopril vs. Irbesartan in Combination with a Thiazide Diuretic in Hypertensive Patients with Multiple Risk Factors not Controlled by a Previous Monotherapy: A Review of the Double-Blind, Randomized “Z” Studies

et al. 2017

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“…10,11 Finally, ARBs reduce the collagen content of the arteries and attenuate extracellular matrix remodelling, thereby improving arterial distensibility. 12 Over the last few years, sodium-glucose co-transporter-2 (SGLT2) inhibitors have been introduced as a therapeutic option for T2D management. These agents induce glycosuria, thereby reducing hyperglycaemia, and reduce the risks of CV disease and end-stage kidney disease in people with or without diabetes and in people with chronic kidney disease (CKD).…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 Finally, ARBs reduce the collagen content of the arteries and attenuate extracellular matrix remodelling, thereby improving arterial distensibility. 12 …”

Section: Introductionmentioning

confidence: 99%

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Mechanisms underlying the blood pressure‐lowering effects of empagliflozin, losartan and their combination in people with type 2 diabetes: A secondary analysis of a randomized crossover trial

Scholtes

Mosterd

Hesp

et al. 2022

Diabetes Obesity Metabolism

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Aim: To study the effects of the sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin, the angiotensin receptor blocker (ARB) losartan, and their combination on blood pressure, while studying the mechanisms potentially involved.Methods: A total of 24 people with type 2 diabetes (T2D) (age: 66 ± 6 years; body mass index: 31.0 ± 3 kg/m 2 ; estimated glomerular filtration rate: 90 ml/min/1.73m 2 ) received a 1-week treatment with empagliflozin 10 mg once daily, losartan 50 mg once daily, their combination, and placebo, in a randomized double-blind crossover design, with 4-week washout periods in between. Blood pressure, arterial stiffness, autonomic nervous system activity and plasma volume, extracellular fluid and serum albumin were assessed.Results: Versus placebo (139 mmHg), empagliflozin reduced systolic blood pressure (SBP) by 8 mmHg (P = .001), losartan by 12 mmHg (P = .001) and empagliflozin + losartan by 15 mmHg (P < .001). Combination therapy had a larger SBP-lowering effect versus empagliflozin monotherapy (-7 [95% CI -12; -2] mmHg) and numerically larger effects versus losartan monotherapy (-3 [-8; 2] mmHg). Empagliflozin reduced sympathetic nervous system (SNS) activity, arterial stiffness and extracellular fluid, while increasing serum albumin. Losartan reduced SNS activity and arterial stiffness.Combination therapy induced volume contraction variables, together with a reduction in SNS activity and arterial stiffness. Conclusion:In people with T2D, SGLT2 inhibition in combination with an ARB had a larger blood pressure-lowering effect versus placebo than either of the drugs alone.

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

Cited by 2 publications

References 8 publications

Efficacy of Zofenopril vs. Irbesartan in Combination with a Thiazide Diuretic in Hypertensive Patients with Multiple Risk Factors not Controlled by a Previous Monotherapy: A Review of the Double-Blind, Randomized “Z” Studies

Efficacy of Zofenopril vs. Irbesartan in Combination with a Thiazide Diuretic in Hypertensive Patients with Multiple Risk Factors not Controlled by a Previous Monotherapy: A Review of the Double-Blind, Randomized “Z” Studies

Mechanisms underlying the blood pressure‐lowering effects of empagliflozin, losartan and their combination in people with type 2 diabetes: A secondary analysis of a randomized crossover trial

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