Effect of Lisinopril and Atenolol on Aortic Stiffness in Patients on Hemodialysis

Abstract

Background and objectives Whether improvements in arterial compliance with BP lowering are because of BP reduction alone or if pleiotropic effects of antihypertensive agents contribute remains unclear. It was hypothesized that, among patients on hemodialysis, compared with a b-blocker (atenolol), a lisinopril-based therapy will better reduce arterial stiffness.Design, setting, participants, & measurements Among 200 participants of the Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril Trial, 179 patients with valid assessment of aortic pulse wave velocity at baseline (89 patients randomly assigned to open-label lisinopril and 90 patients randomly assigned to atenolol three times a week after dialysis) were included in the secondary analysis. Among them, 109 patients had a valid pulse wave velocity measurement at 6 months. Monthly measured home BP was targeted to ,140/90 mmHg by addition of antihypertensive drugs and dry weight adjustment. The difference between drugs in percentage change of aortic pulse wave velocity from baseline to 6 months was analyzed.Results Contrary to the hypothesis, atenolol-based treatment induced greater reduction in aortic pulse wave velocity relative to lisinopril (between drug difference, 14.8%; 95% confidence interval, 1.5% to 28.5%; P=0.03). 218.4, 20.9] mmHg, respectively; P=0.30 for diastolic BP). Between-drug difference in change of aortic pulse wave velocity persisted after adjustments for age, sex, race, other cardiovascular risk factors, and baseline ambulatory systolic BP but disappeared after adjustment for change in ambulatory systolic BP (11.8%; 95% confidence interval, 22.3% to 25.9%; P=0.10).Conclusions Among patients on dialysis, atenolol was superior in improving arterial stiffness. However, differences between atenolol and lisinopril in improving aortic stiffness among patients on hemodialysis may be explained by BP-lowering effects of drugs.

Blood Pressure and Risk of Cardiovascular Events in Patients on Chronic Hemodialysis

“…Although currently there are no medications that specifically target PP, a marker of arterial stiffness, a recent clinical trial of HD patients reported that atenolol was superior to lisinopril in improving arterial stiffness. 45 Thus, understanding the relationship of various BP components with outcomes among HD patients may help in selection of appropriate BP medications as more therapies emerge.…”

Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

“…Their findings mainly targeting the non-dialysis population confirmed our results in dialysis patients. Additionally, β-blockers were superior in improving arterial stiffness, left ventricular function, and long-term control of hypertension in dialysis patients so that they were able to reduce malignant cardiovascular events [39][40][41]. In this systematic review, data regarding incorporated RCTs displayed that the benefits of β-blockers for all-cause mortality, cardiovascular mortality, cardiovascular events, and hospitalizations in dialysis patients were similar to those in people who did not receive dialysis.…”

Effects of 2-year vitamin B12 and folic acid supplementation in hyperhomocysteinemic elderly on arterial stiffness and cardiovascular outcomes within the B-PROOF trial

“…Third, we acknowledge that the follow-up period of 2 years is relatively short for cardiovascular outcome parameters. Our study was designed to study the effect of vitamin B12 and folic acid supplementation on PWV, and for this parameter, a 2-year intervention is considered to be sufficient, because PWV is known to respond quickly as other trials with PWV as outcome variable have shown [8,29,30]. Nevertheless, arterial stiffness is known for its limited reversibility and therefore it cannot be ruled out that differences in PWV levels may have been detected when using a longer intervention period.…”