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Effect of angiotensin II blockade on central blood pressure and arterial stiffness in subjects with hypertension.

Safar ME - Int J Nephrol Renovasc Dis (2010)

Bottom Line: The angiotensin-converting enzyme (ACE) inhibitor perindopril not only reduces mean arterial pressure but also acts specifically on pulse pressure.In hypertensive subjects, perindopril and other ACE inhibitors seem to predict more consistently the reduction of cardiovascular events, mainly of cardiac origin, than standard β-blockers alone.This effect is associated with the important biochemical finding that mechanotransductions of angiotensin and β-blockade are markedly different, acting in the former specifically on the α5β1 integrin complex and on the fibronectin ligand of arterial vessels.

View Article: PubMed Central - PubMed

Affiliation: Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu Centre de Diagnostic et de Thérapeutique, Paris, France. michel.safar@htd.aphp.fr

No MeSH data available.


Related in: MedlinePlus

Incidence of all renal events in ADVANCE31 according to achieved blood pressure levels, adjusted for age, gender, duration of diabetes, glycosylated hemoglobin, currently treated hypertension, history of macrovascular disease, electrocardiogram abnormalities (ventricular hypertrophy, Q waves, or atrial fibrillation), triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, current smoking, current alcohol use, and study drug. Solid boxes represent estimates of event rates, centers of which are placed at the intersection of the point estimate and median systolic blood pressure value. Areas of the boxes are proportional to the number of events, and vertical bars represent 95% confidence interval. The rate of all renal events was significantly associated with achieved systolic blood pressure levels (P < 0.0001).Abbreviation: ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation study.
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f5-ijnrd-3-167: Incidence of all renal events in ADVANCE31 according to achieved blood pressure levels, adjusted for age, gender, duration of diabetes, glycosylated hemoglobin, currently treated hypertension, history of macrovascular disease, electrocardiogram abnormalities (ventricular hypertrophy, Q waves, or atrial fibrillation), triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, current smoking, current alcohol use, and study drug. Solid boxes represent estimates of event rates, centers of which are placed at the intersection of the point estimate and median systolic blood pressure value. Areas of the boxes are proportional to the number of events, and vertical bars represent 95% confidence interval. The rate of all renal events was significantly associated with achieved systolic blood pressure levels (P < 0.0001).Abbreviation: ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation study.

Mentions: REASON (Preterax in Regression of Arterial Stiffness in a Controlled Double-blind Study)11 was the first clinical trial to investigate the long-term effects of antihypertensive drug treatment on central systolic BP and pulse pressure, aortic stiffness, and wave reflections. It was conducted in middle-aged hypertensive subjects. Administration of perindopril, combined with a low dose of the diuretic indapamide, was compared with the effect of the β-blocking agent atenolol for one year. For the same diastolic BP and mean arterial pressure reduction, perindopril plus indapamide lowered systolic BP and pulse pressure more than atenolol (Figure 4). Moreover, the reduction was significantly more pronounced centrally (carotid artery) than peripherally (brachial artery, Figure 5). Although the two drug regimens lowered pulse wave velocity equally, only perindopril plus indapamide reduced central (carotid) pulse pressure and augmentation index.1–3,11,12 Central pulse pressure and augmentation index remained unchanged with atenolol. Furthermore, perindopril plus indapamide decreased cardiac hypertrophy more than atenolol. This effect was attributed to the augmentation index decline, indicating that the reduction of cardiac mass was related to central wave reflections.13–15 Furthermore, on drug treatment, the selective lowering of systolic BP (but not diastolic BP) with perindopril plus indapamide was significantly predicted by the baseline pulse wave velocity value. Thus, REASON emphasized the predictive values of pulse wave velocity, central systolic BP, and pulse pressure in the mechanisms of BP reduction in hypertensive subjects.16 A confirmation of all these findings was obtained later from ASCOT (the Anglo-Scandinavian Cardiac Outcomes Trial) in which the role of central BP as predictive of cardiovascular events was further confirmed.17


Effect of angiotensin II blockade on central blood pressure and arterial stiffness in subjects with hypertension.

Safar ME - Int J Nephrol Renovasc Dis (2010)

Incidence of all renal events in ADVANCE31 according to achieved blood pressure levels, adjusted for age, gender, duration of diabetes, glycosylated hemoglobin, currently treated hypertension, history of macrovascular disease, electrocardiogram abnormalities (ventricular hypertrophy, Q waves, or atrial fibrillation), triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, current smoking, current alcohol use, and study drug. Solid boxes represent estimates of event rates, centers of which are placed at the intersection of the point estimate and median systolic blood pressure value. Areas of the boxes are proportional to the number of events, and vertical bars represent 95% confidence interval. The rate of all renal events was significantly associated with achieved systolic blood pressure levels (P < 0.0001).Abbreviation: ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation study.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108785&req=5

f5-ijnrd-3-167: Incidence of all renal events in ADVANCE31 according to achieved blood pressure levels, adjusted for age, gender, duration of diabetes, glycosylated hemoglobin, currently treated hypertension, history of macrovascular disease, electrocardiogram abnormalities (ventricular hypertrophy, Q waves, or atrial fibrillation), triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, current smoking, current alcohol use, and study drug. Solid boxes represent estimates of event rates, centers of which are placed at the intersection of the point estimate and median systolic blood pressure value. Areas of the boxes are proportional to the number of events, and vertical bars represent 95% confidence interval. The rate of all renal events was significantly associated with achieved systolic blood pressure levels (P < 0.0001).Abbreviation: ADVANCE, Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation study.
Mentions: REASON (Preterax in Regression of Arterial Stiffness in a Controlled Double-blind Study)11 was the first clinical trial to investigate the long-term effects of antihypertensive drug treatment on central systolic BP and pulse pressure, aortic stiffness, and wave reflections. It was conducted in middle-aged hypertensive subjects. Administration of perindopril, combined with a low dose of the diuretic indapamide, was compared with the effect of the β-blocking agent atenolol for one year. For the same diastolic BP and mean arterial pressure reduction, perindopril plus indapamide lowered systolic BP and pulse pressure more than atenolol (Figure 4). Moreover, the reduction was significantly more pronounced centrally (carotid artery) than peripherally (brachial artery, Figure 5). Although the two drug regimens lowered pulse wave velocity equally, only perindopril plus indapamide reduced central (carotid) pulse pressure and augmentation index.1–3,11,12 Central pulse pressure and augmentation index remained unchanged with atenolol. Furthermore, perindopril plus indapamide decreased cardiac hypertrophy more than atenolol. This effect was attributed to the augmentation index decline, indicating that the reduction of cardiac mass was related to central wave reflections.13–15 Furthermore, on drug treatment, the selective lowering of systolic BP (but not diastolic BP) with perindopril plus indapamide was significantly predicted by the baseline pulse wave velocity value. Thus, REASON emphasized the predictive values of pulse wave velocity, central systolic BP, and pulse pressure in the mechanisms of BP reduction in hypertensive subjects.16 A confirmation of all these findings was obtained later from ASCOT (the Anglo-Scandinavian Cardiac Outcomes Trial) in which the role of central BP as predictive of cardiovascular events was further confirmed.17

Bottom Line: The angiotensin-converting enzyme (ACE) inhibitor perindopril not only reduces mean arterial pressure but also acts specifically on pulse pressure.In hypertensive subjects, perindopril and other ACE inhibitors seem to predict more consistently the reduction of cardiovascular events, mainly of cardiac origin, than standard β-blockers alone.This effect is associated with the important biochemical finding that mechanotransductions of angiotensin and β-blockade are markedly different, acting in the former specifically on the α5β1 integrin complex and on the fibronectin ligand of arterial vessels.

View Article: PubMed Central - PubMed

Affiliation: Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu Centre de Diagnostic et de Thérapeutique, Paris, France. michel.safar@htd.aphp.fr

No MeSH data available.


Related in: MedlinePlus