54 research outputs found
Endothelin antagonism on aldosterone-induced oxidative stress and vascular remodeling
No full textEndothelin A (ETA) receptor blockade has prevented vascular remodeling in aldosterone and salt-induced hypertension. To evaluate effects of the ETA receptor antagonist, BMS 182874, compared with the aldosterone antagonist, spironolactone, on vascular remodeling in aldosterone-infused rats not exposed to a high salt diet, Sprague-Dawley rats were infused subcutaneously with aldosterone (0.75 μg/h) and treated with BMS 182874 (40 mg · kg−1 · d−1), spironolactone, or hydralazine (both 25 mg · kg−1 · d−1) while receiving a normal salt diet for 6 weeks. Aldosterone increased systolic BP (P<0.01), plasma endothelin (3.33±0.32 versus 1.85±0.40 pmol/L in control, P<0.05), systemic oxidative stress as shown by plasma thiobarbituric acid–reacting substances and vascular nicotinamide adenine dinucleotide phosphate (NADPH) activity. Aldosterone increased small artery media thickness (17.7±0.9 versus 13.6±0.8 μm in control, P<0.05) and media/lumen ratio (7.6±0.4 versus 5.5±0.4% in control, P<0.05), with growth index of 21% indicating hypertrophic remodeling. Laser confocal microscopy showed increased collagen and fibronectin deposition and intercellular adhesion molecule-1 (ICAM-1) content in the vessel wall of aldosterone-infused rats. The 3 treatments lowered BP, although hydralazine was slightly less effective. BMS 182874 and spironolactone decreased oxidative stress, normalized the hypertrophic remodeling, decreased collagen and fibronectin deposition, and reduced ICAM-1 abundance in the vascular wall of aldosterone-infused rats, whereas hydralazine only reduced NADPH activity in aorta but did not affect the remaining parameters. Vascular remodeling of small arteries occurs in aldosterone-infused rats exposed to a normal salt diet and may be mediated in part by ET-1 via stimulation of ETA receptors. Endothelin blockade may exert beneficial effects on vascular remodeling, fibrosis, oxidative stress, and adhesion molecule expression in aldosterone-induced hypertension
Effect of hyperhomocystinemia and hypertension on endothelial function in methylenetetrahydrofolate reductase-deficient mice
No full text<b>Objective—</b> We evaluated the effect of hyperhomocystinemia and angiotensin (Ang) II on vascular function and structure in methylenetetrahydrofolate reductase knockout mice (Mthfr+/−).<p></p>
<b>Methods and Results—</b> Mthfr+/− and controls (Mthfr+/+) received Ang II (400 ng/kg per min SC) or saline (14 days). Blood pressure, similar in Mthfr+/− and Mthfr+/+, was increased by Ang II. Acetylcholine- and bradykinin-induced relaxations were impaired in mesenteric resistance arteries (pressurized myograph) in Mthfr+/− and in Ang II–infused Mthfr+/+ mice and additionally blunted in Ang II–infused Mthfr+/− mice. The inhibition by L-NAME on acetylcholine was reduced in Mthfr+/− and in Ang II–Mthfr+/+ and absent in Ang II–Mthfr+/− mice. In these groups, vitamin C improved the response to acetylcholine and restored the inhibition by L-NAME. The media to lumen ratio of small arteries, similar in Mthfr+/− and Mthfr+/+, was increased by Ang II. Vascular NADPH oxidase activity, similar in Mthfr+/− and Mthfr+/+, increased after Ang II infusion. Vascular xanthine oxidase activity was also similar in Mthfr+/− and Mthfr+/+. Superoxide production in the aorta was reduced by sepiapterin and by L-NAME, suggesting that reduced bioavailability of tetrahydrobiopterin and uncoupling of nitric oxide synthase were the origin of increased reactive oxygen species in this model.<p></p>
<b>Conclusions—</b> Mthfr+/− mice show endothelial dysfunction of mesenteric vessels probably attributable to a reduced nitric oxide bioavailability caused by oxidative excess due to uncoupling of nitric oxide synthase without vascular structural alterations. Concurrent Ang II–induced hypertension additionally reduced nitric oxide, increased NADPH oxidase activity, and induced structural alterations. Our findings suggest additive adverse effect of Ang II–dependent hypertension and hyperhomocystinemia on endothelial function
Cigarette Smoking and Hypertension
No full textCigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases. Impairment of endothelial function, arterial stiffness, inflammation, lipid modification as well as an alteration of antithrombotic and prothrombotic factors are smoking-related major determinants of initiation, and acceleration of the atherothrombotic process, leading to cardiovascular events. Cigarette smoking acutely exerts an hypertensive effect, mainly through the stimulation of the sympathetic nervous system. As concern the impact of chronic smoking on blood pressure, available data do not put clearly in evidence a direct causal relationship between these two cardiovascular risk factors, a concept supported by the evidence that no lower blood pressure values have been observed after chronic smoking cessation. Nevertheless, smoking, affecting arterial stiffness and wave reflection might have greater detrimental effect on central blood pressure, which is more closely related to target organ damage than brachial blood pressure. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to an accelerated atherosclerosis
Comparison of benazepril and losartan on endothelial function and vascular stiffness in hypertensive diabetic patients with hypertension not controlled by amlodipine
No full textEm pacientes hipertensos e diabéticos, o sistema renina-angiotensina-aldosterona está relacionado com disfunção endotelial, rigidez vascular e aterosclerose. As principais medicações disponíveis para a inibição desse sistema são os inibidores da enzima conversora de angiotensina e os bloqueadores do receptor AT1 de angiotensina. A maioria das diretrizes internacionais faz as mesmas recomendações para as duas classes, mas diferenças no seu mecanismo de ação podem ter relevância clínica. O objetivo principal foi comparar benazepril e losartana em pacientes hipertensos e diabéticos com pressão arterial não controlada por anlodipino, analisando parâmetros inflamatórios (proteína C reativa), da função endotelial (através da dilatação mediada por fluxo da artéria braquial) e de rigidez vascular (através da velocidade da onda de pulso e das pressões aórticas). O objetivo secundário foi, através de uma análise post-hoc, pesquisar se há interação entre as estatinas e os inibidores do sistema renina-angiotensina-aldosterona. Pressão arterial, função endotelial e rigidez vascular foram comparados entre usuários e não-usuários de estatina. Os dados estão apresentados como mediana (intervalo interquartil). Os resultados principais mostraram que o grupo benazepril apresentou menor proteína C reativa [0,38 (0,15-0,95) mg/dl vs 0,42 (0,26-0,59) mg/dl, p=0,020]. Houve, ainda, uma leve melhora da dilatação mediada por fluxo da artéria braquial no grupo benazepril (aumento 45%, p=0,057) em comparação com o grupo losartana (aumento 19%, p=0,132). Não houve diferença na velocidade da onda de pulso [8,5 (7,8-9,4) m/s vs 8,5 (7,0-9,7) m/s, p=0,280] e na pressão aórtica sistólica [129 (121-145) mmHg vs 123 (117-130) mmHg, p=0,934] entre os grupos benazepril e losartana. Nos resultados secundários, observou-se que o grupo usuário de estatina apresentou maior redução na pressão arterial sistólica média das 24 horas [134 (120-146) mmHg para 122 (114-135) mmHg, p=0,007] e melhora na dilatação mediada por fluxo da artéria braquial [6,5% (5,1-7,1) para 10,9% (7,3-12,2), p=0,003] quando comparado com o grupo não usuário [137 (122-149) mmHg para 128 (122-140) mmHg, p=0,362, e 7,5% (6,0-10,2) para 8,3% (7,5-9,9), p=0,820, respectivamente]. Não houve diferença na velocidade de onda de pulso e nas pressões aórticas entre usuários ou não de estatina. Pode-se concluir que, em pacientes diabéticos com a pressão arterial não controlada por anlodipino, o benazepril promoveu maior redução da proteína C reativa e melhora da função endotelial em relação à losartana. Além disso, o uso combinado de estatinas, anlodipino e inibidores do sistema renina-angiotensina-aldosterona melhorou a resposta anti-hipertensiva e a função endotelial em pacientes hipertensos e diabéticos.In hypertensive diabetic patients, the renin-angiotensin-aldosterone system is related to endothelial dysfunction, vascular stiffness and atherosclerosis. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are two of the most important medications that inhibit this system. Most international guidelines recommend them interchangeably, albeit small differences may have clinical relevance. The main objective was to compare inflammatory parameters (by C-reactive protein), endothelial function (by flow-mediated vasodilation) and vascular stiffness (by pulse wave velocity and aortic pressures) between benazepril and losartan in hypertensive diabetic patients whose blood pressure was not controlled by amlodipine. The secondary objective was a post-hoc analysis to study possible synergism between statins and renin-angiotensin-aldosterone system inhibitors. Blood pressure reduction, endothelial function and vascular stiffness were compared between patients using or not statins. Main results showed that C-reactive protein had lower values in benazepril group [0.38 (0.15-0.95) mg/dl vs 0.42 (0.26-0.59) mg/dl, p=0.020]. There was a slightly higher flow-mediated vasodilation response in benazepril group (45% of increase, p=0.057) than in losartan group (19% of increase, p=0.132). Aortic systolic blood pressure [129 (121-145) mmHg vs 123 (117-130) mmHg, p=0.934] and carotid-femoral pulse wave velocity [8.5 (7.8-9.4) m/s vs 8.5 (7.0-9.7) m/s, p=0.280] were the same between groups. Secondary results showed that patients using statins had greater reduction in mean systolic blood pressure in 24 hour monitoring [134 (120-146) mmHg to 122 (114-135) mmHg, p=0.007] than patients not using statins [137 (122-149) mmHg to 128 (122-140) mmHg, p=0.362]. Patients using statins had higher flow-mediated vasodilation response [6.5% (5.1-7.1) to 10.9% (7.3-12.2), p=0.003] than those not using statins [7.5% (6.0-10.2) to 8.3% (7.5-9.9), p=0.820]. There was no difference in pulse wave velocity nor in aortic pressure between patients using or not statins. Hypertensive diabetic patients in use of benazepril had a greater reduction in C-reactive protein and a slight improvement in flow-mediated vasodilation than those taking losartan. Moreover, combination of statin, anlodipine and renin-angiotensin-aldosterone system inhibitors promoted greater blood pressure reduction and amelioration of endothelial function in hypertensive diabetic patients
Hypertension in the elderly: an evidence-based review.
No full textThe progressive ageing of world population, and the increasing prevalence hypertension in elderly people are leading to the consideration that hypertension in the elderly is one of the main topic in hypertension treatment. Multiple mechanisms, including stiffening of large arteries, endothelial dysfunction, cardiac remodeling, autonomic dysregulation, renal aspects, contribute to the great prevalence of hypertension in the elderly and to increased cardiovascular morbidity and mortality. Treatment of hypertension can hardly put back older patients in a low risk category, especially if target organ damage is present. Nevertheless, blood pressure control can successfully prevent stroke, cognitive decline, coronary heart disease and heart failure, and reduce mortality in the elderly, and even in patients > 80 years, as recently demonstrated. Blood pressure should be lowered below 140/90 mmHg also in older patients. However the HYVET study suggests that a goal of 150/90 mmHg can be reasonable in patients aged 80 years or more. Drug treatment should be titrated with particular caution to adverse responses and excessive blood pressure lowering
Analysis of the concordance between the dietary approaches to stop hypertension (DASH) and the alimentary habit of hypertensive patients
No full textA adoção do plano dietético Dietary Approaches to Stop Hypertension (DASH) tem sido enfatizado na população hipertensa como uma importante estratégia no controle dos níveis pressóricos elevados. O objetivo deste estudo foi analisar o consumo alimentar de macro e micronutrientes em pacientes hipertensos, em especial do sódio, cálcio, potássio e magnésio, e comparar com as recomendações dietéticas contidas no plano DASH. Estudo transversal envolvendo uma amostra de conveniência composta por 113 hipertensos entre 40 e 69 anos. A medida da pressão arterial (PA) foi determinada com aparelho eletrônico devidamente calibrado e a avaliação dietética obtida pelo questionário de freqüência do consumo alimentar. Os alimentos ingeridos foram convertidos em porções e distribuídos em diferentes grupos alimentares. A faixa de porções recomendadas pelo plano DASH foi determinada com base na média das necessidades energéticas desta amostra permitindo assim uma posterior comparação com o hábito alimentar dos hipertensos, utilizando um escore de pontos com pontuação máxima de 9 pontos. A amostra foi dividida em três grupos: grupo B que obteve 2,5 a 4,0 pontos (n=34; 30%), grupo M entre 4,5 a 5,0 pontos (n=43; 38%) e grupo A que obteve 5,5 a 8,0 pontos (n=36; 32%). Não foram observadas diferenças significativas na média da PA sistólica (14024 vs 13823 vs 13515 mmHg) e diastólica (8617 vs 8813 vs 8410 mmHg). Apesar do grupo A consumir mais proteínas e gordura monoinsaturada, foi detectado um excesso pronunciado na ingestão de gordura saturada, colesterol e das calorias totais, por este grupo de pacientes. No que tange a ingestão dos micronutrientes, o grupo A apresentou consumo significativamente maior de cálcio, potássio e magnésio, refletido pela maior ingestão de vegetais e frutas em comparação aos grupos B e M. A média de ingestão do sódio intrínseco foi significativamente maior no grupo A (4,12,0 vs 3,11,1 vs 2,71,1 g/dia). Foram detectadas, apenas no grupo A, correlações entre PA sistólica e o percentual de proteína (r = -0,5; p=0,002) e PA sistólica e o percentual de carboidrato (r = 0,4; p=0,02). Apenas um terço dos hipertensos avaliados apresentaram padrão alimentar mais concordante com o plano DASH e com maior ingestão de proteínas, gordura monoinsaturada, fibras, cálcio, potássio e magnésio. Entretanto, o consumo mais elevado de sódio, gordura saturada, colesterol e das calorias totais por este grupo de pacientes poderia restringir uma maior queda dos níveis pressóricos elevados.The adoption of the Dietary Approaches to Stop Hypertension (DASH) plan has been emphasized in the hypertension population as an important strategy in the control of the raised blood pressure (BP). The objective of this study was to analyze the alimentary consumption of macro and micronutrients in hypertensive patients, especially of sodium, calcium, potassium and magnesium, and to compare with the dietary recommendations contained in DASH plan. Transversal study was conducted in a convenience sample of 113 hypertensive patients, between 40 and 69 years. The BP measurement was determined with calibrated electronic device and the dietary assessment was performed trough the semiquantitative food frequency questionnaire. For comparison with DASH plan, ingested foods were converted into portions and the magnitude of the portions recommended for DASH plan was determined on the basis of the mean energy requirements of this sample. Thereafter, cut-off points were established for food groups, the maximum number of points that a patient could reach was 9. The sample was divided in tertils: Group L with 2.5 4.0 points (n=34; 30%), Group I with 4.5 5.0 points (n=43; 38%) and Group H with 5.5 8.0 points (n=36; 32%). Systolic and diastolic BP were not significantly different among the groups (14024 vs 13823 vs 13515 mmHg/ 8617 vs 8813 vs 8410 mmHg). Group H consumed more proteins and monoinsaturated fat, a pronounced excess in the saturated fat, cholesterol and total calories intake was also detected in this group of patients. Regarding micronutrients intake, group H presented significantly higher consumption of calcium, potassium and magnesium, reflected for higher vegetable and fruits intake in comparison to the groups L and I. The average of intrinsic sodium intake was significantly higher in the group H (4.12.0 vs 3.11.1 vs 2.71.1 g/day). Negative correlation between the systolic BP and dietary protein percentage (r=-0.5, p=0.002) and a positive correlation between the systolic BP and the carbohydrate percentage (r=0.4, p=0.02) was verified only in group H. The present study showed that only one third of the hypertensive patients presented alimentary pattern more consistent with DASH plan, showing greater intake of protein, monounsaturated fat, fiber, calcium, potassium and magnesium. However, pronounced sodium, saturated fat and cholesterol intake and excess of total calories in these hypertensive patients could restrict a greater control of BP
Pulse wave velocity in youngs adults followed for 18 years: impact of blood pressure, anthropometric, inflammatory and endothelial function variables. The Rio de Janeiro study.
No full textDados sobre a avaliação não invasiva da rigidez vascular e suas relações com variáveis de risco cardiovascular são escassos em jovens. Objetiva avaliar a relação entre a velocidade de onda de pulso (VOP) e a pressão arterial (PA),
variáveis antropométricas, metabólicas, inflamatórias e de disfunção endotelial em indivíduos adultos jovens. Foram estudados 96 indivíduos (51 homens) do Estudo do Rio de Janeiro, em duas avaliações, A1 e A2, com intervalo de 17,691,58 anos (16 a 21 anos). Em A1 foram avaliados em suas escolas (10-15 anos - média 12,421,47 anos) e em A2 foram novamente avaliados em nível ambulatorial (26-35
anos - média 30,091,92 anos). Em A1 foram obtidos pressão arterial (PA) e índice de massa corporal (IMC). Em A2 foram obtidos a velocidade da onda de pulso (VOP)-método Complior, PA, IMC, circunferência abdominal (CA), glicose, perfil lipídico, leptina, insulina, adiponectina, o índice de resistência à insulina HOMA-IR, proteína C-Reativa ultrassensível (PCRus) e as moléculas de adesão E-selectina,
Vascular Cell Adhesion Molecule-1(VCAM-1) e Intercellular Adhesion Molecule-1 (ICAM-1). Foram obtidos, ainda, a variação da PA e do IMC entre as 2 avaliações. Em A2 os indivíduos foram estratificados segundo o tercil da VOP para cada sexo. Como resultados temos: 1) Os grupos foram constituídos da seguinte forma: Tercil 1:homens com VOP < 8,69 m/s e mulheres com VOP < 7,66 m/s; Tercil 2: homens
com VOP ≥ 8,69 m/s e < 9,65m/s e mulheres com VOP ≥ 7,66 m/s e < 8,31m/s;Tercil 3:homens com VOP ≥ 9,65 m/s e mulheres com VOP ≥ 8,31 m/s. 2) O grupo com maior tercil de VOP mostrou maiores médias de PA sistólica (PAS) (p=0,005), PA diastólica (PAD) (p=0,007), PA média (PAM) (p=0,004), variação da PAD (p=0,032), variação da PAM (p=0,003), IMC (p=0,046), variação do IMC (p=0,020), insulina (p=0,019), HOMA-IR (p=0,021), E-selectina (p=0,032) e menores médias de adiponectina (p=0,016), além de maiores prevalências de diabetes mellitus/intolerância à glicose (p=0,022) e hiperinsulinemia (p=0,038); 3) Houve correlação significativa e positiva da VOP com PAS (p<0,001), PAD (p<0,001), PP (p=0,048) e PAM (p<0,001) de A2, com a variação da pressão arterial (PAS, PAD e PAM) (p<0,001) entre as duas avaliações, com o IMC de A2 (p=0,005) e com a variação do IMC (p<0,001) entre as duas avaliações, com CA (p=0,001), LDLcolesterol
(p=0,049) e E-selectina (p<0,001) e correlação negativa com HDLcolesterol (p<0,001) e adiponectina (p<0,001); 4)Em modelo de regressão múltipla, após ajuste do HDL-colesterol, LDLcolesterol e adiponectina para sexo, idade, IMC e PAM, apenas o sexo masculino e a PAM mantiveram correlação significativa com a VOP. A VOP em adultos jovens mostrou relação significativa com variáveis de risco
cardiovascular, destacando-se o sexo masculino e a PAM como importantes variáveis no seu determinismo. Os achados sugerem que a medida da VOP pode ser útil para a identificação do acometimento vascular nessa faixa etária.Data on non-invasive evaluation of vascular stiffness in the young and its relationship with cardiovascular (CV) risk variables are scarce. Objective to assess the relationship between pulse wave velocity (PWV) and blood pressure (BP), anthropometric, metabolic, inflammatory and endothelial dysfunction variables in young adults. Ninety-six individuals (51 males) from The Rio de Janeiro Study cohort were studied in two evaluations, A1 and A2, with an interval of 17.69 1.58 years (16-21 years). In A 1 they were evaluated at their schools (10-15 years average 12.42 1.47 years) and in A2 they were all re-evaluated as outpatients (26-35 years - average 30.09 1.92 years). In A1 BP and body mass index (BMI) were obtained. In A2 pulse wave velocity (PWV) by Complior method, BP, BMI, waist circumference (WC), glucose, lipid profile, leptin, insulin, adiponectin, the HOMA-IR insulin resistance index, high sensitive C-Reactive protein (CRPhs) and E-selectin, Vascular Cell Adhesion Molecule 1 (VCAM-1) and Intercellular Adhesion Molecule 1 (ICAM-1) adhesion molecules were obtained. The BP and BMI variation over the time interval between the two evaluations were also obtained. Subjects were stratified according to tertile of PWV for each sex in A2. As results: 1) The groups were constituted as follows: Tertile 1: males with PWV <8.69 m/s and females with PWV <7.66 m/s; Tertile 2: males with PWV ≥ 8.69 m/s and <9.65 m/s and females with PWV ≥ 7.66 m/s and <8.31 m/s; Tertile 3: males with PWV ≥ 9.65 m/s and females with PWV ≥ 8.31 m/s 2) The group with the highest PWV tertile showed higher values of systolic BP (SBP) (p=0.005), diastolic BP (DBP) (p=0.007), mean BP (MBP) (p=0,004), DBP variation (p=0,032), MBP variation (p=0.033), BMI (p=0.046), BMI variation (p=0.020), insulin (p=0.019), HOMA-IR (p=0.021), E-Selectin (p=0.032) and lower values of adiponectin (p=0.016), besides higher prevalence of diabetes mellitus/glucose intolerance (p=0.022) and hyperinsulinemia (p=0.038); 3) There were a significant positive correlation of PWV with SBP (p<0,001), DBP (p<0,001), PP (p=0,048) and MBP (p<0,001) from A2, variation in blood pressure (SBP, DBP, and MBP) (p<0,001) between the two assessments, BMI (p=0.005) and BMI variation between the two evaluations (p<0,001), WC (p=0.001), LDL-cholesterol (0.049), and E-selectin (p<0,001) and negative correlation with HDL-cholesterol (p<0,001) and adiponectin (p<0,001); 4) In the multiple regression model, HDL-cholesterol, LDL-cholesterol and adiponectin lost statistical significance after adjustment for sex, age, BMI and MBP, only the male gender and MBP remained significantly correlated with PWV. PWV in young adults showed a significant association with CV risk variables, highlighting the male gender and MBP as important variables in its determining. The findings suggest that measurement of PWV can be useful for the identification of vascular impairment in this age group
Spironolactone improves Angiotensin-induced vascular changes and oxidative stress
No full textAngiotensin II plays an important role in vascular remodeling. We investigated the role of aldosterone, which is stimulated by angiotensin II, as a mediator of angiotensin II–induced vascular structural and functional alterations. Sprague-Dawley rats (n=8 to 12/group) received angiotensin II (120 ng/kg per minute, subcutaneously) for 14 days ± spironolactone or hydralazine (25 mg/kg per day). An additional group received aldosterone (750 ng/h, subcutaneously) ± spironolactone. Systolic blood pressure was increased by angiotensin II (P<0.001) and reduced by spironolactone and hydralazine (P<0.001). Aldosterone-induced increase of blood pressure was reduced by spironolactone (P<0.05). In mesenteric small arteries studied on a pressurized myograph, media/lumen ratio was increased (P<0.001) and acetylcholine-mediated relaxation was impaired in angiotensin II–infused rats (P<0.001); both were partially improved by spironolactone (P<0.05) but not by hydralazine. Aldosterone-induced increase of media/lumen ratio (P<0.001) and impaired response to acetylcholine (P<0.001) were normalized by spironolactone. Response to sodium nitroprusside was similar in all groups. Aortic NADPH oxidase activity was increased (P<0.01) by angiotensin II and reduced by spironolactone and hydralazine. Aldosterone also increased (P<0.05) activation of NADPH oxidase, an effect abolished by spironolactone. Plasma thiobarbituric acid–reactive substances (a marker of oxidative stress), higher in angiotensin II and aldosterone rats (P<0.001), were normalized by spironolactone. In conclusion, spironolactone, which inhibited aldosterone actions, partially corrected structural and functional angiotensin II–induced abnormalities. These effects were associated with reduced vascular NADPH oxidase activity and decreased plasma markers of oxidative stress. Our findings suggest that aldosterone may mediate some of angiotensin II–induced vascular effects in hypertension, in part via increased oxidative stress
Renin-Angiotensin System Blockade Associated with Statin Improves Endothelial Function in Diabetics
No full textAbstractBackground:Studies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness.Objective:To analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness.Methods:Patients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively).Results:The SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586).Conclusion:Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes
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