Effect of aliskiren treatment on endothelium-dependent vasodilation and aortic stiffness in essential hypertensive patients

Virdis, Agostino; Ghiadoni, Lorenzo; Qasem, Ahmad Amedeo; Lorenzini, Gianni; Duranti, Emiliano; Cartoni, G.; Bruno, Rosa Maria; Bernini, Giampaolo; Taddei, Stefano

doi:10.1093/eurheartj/ehs057

Cited by 54 publications

(41 citation statements)

References 34 publications

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“…98 Aliskiren, a novel direct renin inhibitor, has been recently studied in humans by Virdis in a comparative study against ramipril. 99 Aliskiren produced a significantly greater reduction in augmentation index and improved the vasodilatory response to acetylcholine, however blood pressure and pulse wave velocity reduction was the same in both groups. Dorresteijn et al also suggest that aliskiren may provide benefits in endothelial function in comparison to moxonidine or hydrochlorothiazide.…”

Section: The Renin-angiotensin-aldosterone Systemmentioning

confidence: 86%

Endothelial dysfunction in human essential hypertension

Mordi

Delles

et al. 2016

Journal of Hypertension

125

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Abstract:Although the endothelium has a number of important functions, the term endothelial dysfunction is commonly used to describe impairment in its vasodilatory capacity. It is increasingly recognised that this is related to hypertension, although whether it predates hypertension or is a consequence of it is still unknown. In this review we explore the mechanisms of endothelial dysfunction in hypertension, its prognostic significance and methods of pharmacological reversal. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation CONDENSED ABSTRACTEndothelial dysfunction is prevalent in hypertension and has a recognised association with the condition. In this article we review the pathophysiology of endothelial dysfunction in human hypertension, its prognostic significance and methods of pharmacological reversal. We appreciate the opportunity to revise this manuscript again and particularly would like to thank Reviewer whose constructive criticism has certainly improved the manuscript. We have addressed the minor comments suggested as attached to this letter.We are extremely grateful once again to the reviewers and the editors for their detailed critique which has undoubtedly improved the quality of the manuscript.We thank you once again for the opportunity to resubmit our manuscript and look forward to your decision. Yours sincerely Dr Ify Mordi Submission letterReviewer #2:I thank you the author for their last revision: the paper improved quite a lot! Just few points should be still addressed:We thank the reviewer for their positive appraisal of our revised manuscript -we agree that the comments provided have substantially improved the review. We agree with the reviewer that this sentence is out of place. Given the length of the review and the fact that this is covered elsewhere we have now deleted the sentence.-Please move the description of micromyography to the invasive methods as tissue biopsies are necessary.We thank the reviewer for pointing out this error. We have now moved the description of myography to the invasive methods section (page 5). We have no conflict of interest. Endothelial Dysfunction in Human Essential Hypertension Manuscript 2 ABSTRACTAlthough the endothelium has a number of important functions, the term endothelial

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Section: The Renin-angiotensin-aldosterone Systemmentioning

confidence: 86%

Endothelial dysfunction in human essential hypertension

Mordi

Delles

et al. 2016

Journal of Hypertension

125

View full text Add to dashboard Cite

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“…Direct Treatment of PWV A number of short-term randomised controlled trials investigating the blockade/ inhibition of renin [71], angiotensin converting enzyme/ angiotensin AT1 receptor blockers [72][73][74][75][76][77][78][79][80], endothelin [81], aldosterone [82,83], phosphodiesterase V [84,85], HMGcoA reductase [86][87][88][89][90][91][92] and xanthine oxidase [93] have been shown to reduce aortic PWV. An important randomised trial in patients with early renal impairment showed both PWV and left ventricular mass reduction over 1 year on just 25 mg spironolactone versus placebo, which the authors claimed was independent of BP [94].…”

Section: Origins Of Arterial Stiffness and Nurture Versus Nature?mentioning

confidence: 99%

Future Treatment of Hypertension: Shifting the Focus from Blood Pressure Lowering to Arterial Stiffness Modulation?

Fok

Cruickshank

2015

Curr Hypertens Rep

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Isolated systolic hypertension is the commonest form of hypertension from middle age onwards. Achieving target systolic blood pressure (BP) control remains difficult in everyday clinical practice and even under clinical trial conditions. Most antihypertensive medicines were designed to lower peripheral vascular resistance, which was considered the haemodynamic determinant of hypertension; most are effective in reducing steady but not pulsatile components of BP. Arterial stiffness, defined via aortic length-specific pulse wave velocity (PWV), is thought to be an important determinant of pulse pressure widening through its effects on the timing and amplitude of pressure wave reflection, and/or the aorta's Windkessel function, or its excess 'reservoir' pressure. Whereas pulse pressure is neither an independent nor consistent cardiovascular risk factor, particularly below the age of about 60 years, PWV has become the most powerful predictor of cardiovascular outcomes including mortality, independent of systolic, pulse, mean or other BP components. PWV is therefore a more direct target for treatment. This review addresses the potential therapeutic options for targeting arterial stiffness and the role of pulse pressure.

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“…19 These findings were found in hypertensive patients when BP was significantly reduced. On the other hand, valsatran reduced PWV when administered in hypertensive patients with albuminuria.…”

Section: Discussionmentioning

confidence: 91%

Efficacy of aliskiren and valsartan in hypertensive patients with albuminuria: a randomized parallel-group study

Spanos

Kalaitzidis

Karasavvidou

et al. 2012

J Renin Angiotensin Aldosterone Syst

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Introduction: Blockade of the renin-angiotensin system (RAS) is a critical approach to the management of hypertension, especially in proteinuric patients. It is well proven that the direct renin inhibitor aliskiren shows comparable clinical efficacy to the angiotensin II receptor blocker valsartan on blood pressure control and albuminuria. However, there is only limited data on the hand-to-hand effectiveness of these two RAS blockers in improving arterial stiffness. We tested whether aliskiren or valsartan would improve arterial stiffness in hypertensive patients with albuminuria who are already on antihypertensive therapy. Material and methods: Thirty-four patients with hypertension and albuminuria < 1 g, after a wash-out period of three weeks, were randomized to aliskiren or valsartan in a 24-week randomized parallel-group study. Results: A nonsignificant difference in blood pressure was seen between the two treatment groups. Albuminuria was significantly reduced in both groups (56% for the aliskiren group, p < 0.05, and 38% for the valsartan group, p < 0.05). Only valsartan but not aliskiren significantly reduced carotid-femoral pulse wave velocity (-1.1 ± 0.8 m/s (p = 0.02) for valsartan and +0.1 ± 0.7 m/s (ns) for aliskiren). Conclusion:The results of our study showed that valsartan improves arterial stiffness to a significantly greater extent than aliskiren, despite a similar antihypertensive and antiproteinuric effect.

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Effect of aliskiren treatment on endothelium-dependent vasodilation and aortic stiffness in essential hypertensive patients

Abstract: Aliskiren increased nitric oxide availability in the forearm resistance arterioles of EH, an effect probably determined by an antioxidant activity, which can also contribute to improved peripheral wave reflection.

Cited by 54 publications

References 34 publications

Endothelial dysfunction in human essential hypertension

Endothelial dysfunction in human essential hypertension

Future Treatment of Hypertension: Shifting the Focus from Blood Pressure Lowering to Arterial Stiffness Modulation?

Efficacy of aliskiren and valsartan in hypertensive patients with albuminuria: a randomized parallel-group study

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