Evaluation of arterial stiffness in morning hypertension under high-dose valsartan compared to valsartan plus low-dose diuretic

Abstract

Morning hypertension has been reported to be an important risk factor for cardiovascular events, and arterial stiffness bears a relationship with cardiovascular risk. The aim of this study was to evaluate whether high-dose angiotensin II receptor blocker (ARB) treatment has a more beneficial effect on arterial stiffness than regular-dose ARB plus low-dose diuretic treatment in patients with morning hypertension. Forty-three patients, in whom the home systolic blood pressure (BP) in the morning was higher than 140 mm Hg and in the evening was lower than 135 mm Hg, despite treatment with 80 mg valsartan, were randomly assigned to receive 160 mg valsartan (V group, n¼22) or 80 mg valsartan plus low-dose trichlormethiazide (1 mg) (V+D group, n¼21) for 6 months. There were no differences in the patient background characteristics between the two groups. There were no significant differences in BP measured at home between the two groups. The brachial-ankle pulse wave velocity (baPWV) at the time of diagnosis of morning hypertension was similar in the two groups; however, after 6 months of treatment, a greater degree of reduction of the baPWV and a greater degree of reduction of BP in the supine position were observed in the V group compared with the V+D group. Thus, though both high-dose valsartan and valsartan plus diuretic reduced the BP to a similar degree in patients with morning hypertension, high-dose valsartan exerted a greater beneficial effect on arterial stiffness than did valsartan plus diuretic.

Direct Angiotensin II Type 2 Receptor Stimulation in N ω -Nitro- l -Arginine-Methyl Ester–Induced Hypertension

“…AT 1 R antagonists currently not only belong to the gold standard therapies for hypertension and cardioprotection at various stages of the cardiovascular continuum 5,6 but have shown the highest potential for preventing and reducing PWV in hypertension. [7][8][9][10] Also in our study olmesartan completely prevented PWV increase and aortic wall thickening. However, the effects on PWV might depend on the actual BP level and aortic geometry.…”

“…8 Anti-AT 1 R-based therapy was superior over treatment not containing an AT 1 R antagonist in preventing PWV increase in patients with essential hypertension, 9 and highdose valsartan treatment achieved more pronounced brachialankle PWV reduction than low-dose valsartanϩdiuretic despite a similar level of BP reduction in patients with morning hypertension. 10 On the other hand, in the REA-SON (pREterax in regression of Arterial Stiffness in a contrOlled double-bliNd study) Project, both the combination of subtherapeutic doses of perindopril and indapamide or a full dose of atenolol reduced slightly but significantly PWV, yet without any difference between the 2 treatment regimens. 11 In a comparison of 4 major antihypertensive therapies in patients with systolic hypertension, none of the medications (perindopril, atenolol, lercanidipine, or bendrofluazide) was able to reduce PWV, 12 and a 4-week treatment with atenolol reduced PWV in hypertensive patients, whereas perindopril did not.…”

“…8 Anti-AT 1 R-based therapy was superior over treatment not containing an AT 1 R antagonist in preventing PWV increase in patients with essential hypertension, 9 and highdose valsartan treatment achieved more pronounced brachialankle PWV reduction than low-dose valsartanϩdiuretic despite a similar level of BP reduction in patients with morning hypertension. 10 On the other hand, in the REA-SON (pREterax in regression of Arterial Stiffness in a contrOlled double-bliNd study) Project, both the combination of subtherapeutic doses of perindopril and indapamide or a full dose of atenolol reduced slightly but significantly PWV, …”

Effects of smoking cessation on central blood pressure and arterial stiffness

“…Measurement of baPWV was performed as described previously 18. Briefly, baPWV was determined from the pulse waveforms recorded from both forearms and both ankles using the formula PWV (Omron Healthcare, Kyoto, Japan).…”

Effects of Azelnidipine plus OlmesaRTAn versus amlodipine plus olmesartan on central blood pressure and left ventricular mass index: the AORTA study

“…Because AI is influenced by the HR, it was normalized for an HR of 75 bpm (AIx@75) as proposed by Wilkinson et al13 baPWV was also used to assess arterial stiffness. baPWV was performed as described previously 14. Briefly, baPWV was determined from the pulse waveforms recorded from both forearms and both ankles using the formula PWV (Omron Healthcare).…”