Effect of losartan, compared with atenolol, on endothelial function and oxidative stress in patients with type 2 diabetes and hypertension

Flammer, Andreas J.; Hermann, Frank; Wiesli, Peter; Schwegler, Beat; Chenevard, Rémy; Hürlimann, David; Sudano, Isabella; Neidhart, Michel; Riesen, Walter; Ruschitzka, Frank; Lüscher, Thomas F.; Noll, Georg; Lehmann, Roger

doi:10.1097/hjh.0b013e3280287a72

Cited by 84 publications

(81 citation statements)

References 46 publications

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“…Consistent with these findings, RAAS inhibition with the ARB losartan has previously been shown to reduce levels of F 2 isoprostanes in patients with type II diabetes and hypertension. 32 However, considering the small magnitude of the changes, large variability in the data and lack of statistically significant between-treatment differences in the present study, it is unlikely that the observed differences are of clinical relevance. It should be noted that a normal range in healthy volunteers has not been established for many of these biomarkers, and so it is unclear to what extent regression to the mean might have explained some of the observed changes from baseline with drug treatment.…”

Section: Discussionmentioning

confidence: 53%

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Krone

Hanefeld

Hf³

et al. 2010

J Hum Hypertens

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Metabolic syndrome, a cluster of risk factors that increase the risk of cardiovascular morbidity and mortality, is common in patients with hypertension. Chronic renin-angiotensin-aldosterone system (RAAS) activation, shown by elevated plasma renin activity (PRA), is implicated in many of the features of metabolic syndrome. The direct renin inhibitor aliskiren may be of benefit in this patient group as aliskiren targets the RAAS at the rate-limiting step. In this double-blind study, 141 patients with hypertension (mean baseline BP 155/93 mm Hg) and metabolic syndrome (modified National Cholesterol Education Program ATP III criteria) were randomized to aliskiren 300 mg or irbesartan 300 mg once daily. Patients treated with aliskiren 300 mg had their mean sitting blood pressure (BP) lowered by 13.8/ 7.1 mm Hg after 12 weeks, significantly greater (Pp0.001) than the 5.8/2.8 mm Hg reduction observed in patients treated with irbesartan 300 mg. A significantly greater proportion of patients treated with aliskiren achieved BP control to o135/85 mm Hg (29.2 vs 16.7% with irbesartan; P ¼ 0.019). Aliskiren treatment led to a 60% decrease in PRA from baseline, whereas irbesartan increased PRA by 99% (both Po0.001). Aliskiren and irbesartan had similar effects on glucose and lipid profiles and on a panel of biomarkers of inflammation and cardiovascular risk. Both aliskiren and irbesartan were well tolerated. Collectively, these results suggest that aliskiren 300 mg may offer treatment benefits compared with irbesartan 300 mg for BP reduction in patients with hypertension and metabolic syndrome.

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Section: Discussionmentioning

confidence: 53%

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Krone

Hanefeld

Hf³

et al. 2010

J Hum Hypertens

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“…Quantification of endothelial dysfunction can predict therapeutic success of pharmacologic intervention, too. Angiotensin-converting enzyme inhibitors (ACE-I) showed clear improvement of endothelial dysfunction in several modalities [92][93][94]. Additional improvement could be shown for add-on spironolactone in chronic heart failure patients [95].…”

Section: Endothelial Dysfunction-a Hallmark Of Cardiovascular Diseasementioning

confidence: 99%

Endothelial dysfunction in cardiovascular disease and Flammer syndrome—similarities and differences

et al. 2017

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The endothelium has increasingly been recognized as a smart barrier and a key regulator of blood flow in microand macrovascular beds. Endothelial dysfunction marks a stage of atherosclerosis and is an important prognostic marker for cardiovascular disease. Yet, some people who tend to be slim and physically active and with rather low blood pressure show a propensity to respond to certain stimuli such as emotional stress with endothelial-mediated vascular dysregulation (Flammer syndrome). This leads to characteristic vascular symptoms such as cold hands but also a risk for vascularmediated diseases such as normal-tension glaucoma. It is the aim of this review to delineate the differences between Flammer syndrome and its Bcounterpart^endothelial dysfunction in the context of cardiovascular diseases.

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“…16 In a randomized, double-blind, crossover study of men with type 2 diabetes and hypertension, an angiotensin II receptor blocker significantly decreased a marker of oxidative stress (Po0.001) and caused a significant increase of FMD compared with an angiotensin II-converting enzyme inhibitor (P ¼ 0.01). 33 …”

Section: Angiotensin Receptor Blockersmentioning

confidence: 99%

Lifestyle and metabolic approaches to maximizing erectile and vascular health

et al. 2011

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Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity.

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Effect of losartan, compared with atenolol, on endothelial function and oxidative stress in patients with type 2 diabetes and hypertension

Cited by 84 publications

References 46 publications

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Comparative efficacy and safety of aliskiren and irbesartan in patients with hypertension and metabolic syndrome

Endothelial dysfunction in cardiovascular disease and Flammer syndrome—similarities and differences

Lifestyle and metabolic approaches to maximizing erectile and vascular health

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