The impact of different angiotensin II receptor blockers on the stiffness of the large arteries and effectiveness of therapy
DOI:
https://doi.org/10.14739/2310-1210.2022.6.260492Keywords:
antihypertensive therapy, angiotensin II receptor blockers, artery stiffness, Cardio Ankle Vascular IndexAbstract
In recent years, the method of determining the Cardio-Ankle Vascular Index (CAVI) has been introduced into clinical practice, which can be used to determine changes in the stiffness of the large arteries regardless of changes in blood pressure (BP).
Aim. To compare the effect of 12-month angiotensin II receptor blocker (ARB) therapy with olmesartan, azilsartan and telmisartan on the large arteries stiffness based on the CAVI determination.
Material and methods. The study included 126 patients (57 men, 69 women) with hypertension, who were selected to compare the effect of ARB drug therapy on the arterial stiffness by CAVI: olmesartan, azilsartan and telmisartan for 12 months. All patients had mild and moderate hypertension. The patients underwent the following examinations: office BP measurement, ambulatory BP monitoring (ABPM), biochemical blood test, echocardiogram, CAVI, registration of side effects.
Results. The average office systolic BP (SBP) throughout the group was 152.56 ± 1.00 mm Hg, office diastolic BP (DBP) – 94.83 ± 0.58 mm Hg, heart rate (HR) – 72.46 ± 0.80 bpm, 24-hour SBP – 135.60 ± 0.96 mm Hg, 24-hour DBP – 82.41 ± 0.84 mm Hg, 24-hour HR – 71.88 ± 0.89 beats/min., CAVI on the right – 7.89 ± 0.27, CAVI on the left – 8.00 ± 0.31. Office and ambulatory BP indicators were decreased equally in all groups. In the olmesartan group, CAVI was significantly decreased by 7 % on the right (P < 0.05) and 5 % on the left (P < 0.05). In the telmisartan group, CAVI was decreased by 6 % on the right (P < 0.05) and 5 % on the left (P < 0.05). In the azilsartan group, CAVI was significantly decreased by 5 % both on the right (P < 0.05) and left (P < 0.05).
Conclusions. Long-term antihypertensive therapy with three different AT II receptor blockers, olmesartan, azilsartan, and telmisartan has helped to reduce stiffness of the large arteries according to CAVI by 5–7 % from the initial level.
References
Ministry of Health of Ukraine. (2012, May 24). Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry arterialnii hipertenzii [On the approval and implementation of medical and technological documents on the standardization of medical care for hypertension (No. 384)]. https://www.moz.gov.ua/portal/dn_20120524_384.html
Laurent, S., Boutouyrie, P., Asmar, R., Gautier, I., Laloux, B., Guize, L., Ducimetiere, P., & Benetos, A. (2001). Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension, 37(5), 1236-1241. https://doi.org/10.1161/01.hyp.37.5.1236
Mahmud, A., & Feely, J. (2002). Effect of angiotensin ii receptor blockade on arterial stiffness: beyond blood pressure reduction. American journal of hypertension, 15(12), 1092-1095. https://doi.org/10.1016/s0895-7061(02)02982-5
Bokuda, K., Ichihara, A., Sakoda, M., Mito, A., Kinouchi, K., & Itoh, H. (2010). Blood pressure-independent effect of candesartan on cardio-ankle vascular index in hypertensive patients with metabolic syndrome. Vascular health and risk management, 6, 571–578. https://doi.org/10.2147/vhrm.s11958
Yambe, T., Meng, X., Hou, X., Wang, Q., Sekine, K., Shiraishi, Y., Watanabe, M., Yamaguchi, T., Shibata, M., Kuwayama, T., Maruyama, M., Konno, S., & Nitta, S. (2005). Cardio-ankle vascular index (CAVI) for the monitoring of the atherosclerosis after heart transplantation. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 59 Suppl 1, S177-S179. https://doi.org/10.1016/s0753-3322(05)80028-9
Nakamura, K., Tomaru, T., Yamamura, S., Miyashita, Y., Shirai, K., & Noike, H. (2008). Cardio-ankle vascular index is a candidate predictor of coronary atherosclerosis. Circulation journal, 72(4), 598-604. https://doi.org/10.1253/circj.72.598
Ichihara, A., Yamashita, N., Takemitsu, T., Kaneshiro, Y., Sakoda, M., Kurauchi-Mito, A., & Itoh, H. (2008). Cardio-ankle vascular index and ankle pulse wave velocity as a marker of arterial fibrosis in kidney failure treated by hemodialysis. American journal of kidney diseases, 52(5), 947-955. https://doi.org/10.1053/j.ajkd.2008.06.007
Shirai, K., Utino, J., Saiki, A., Endo, K., Ohira, M., Nagayama, D., Tatsuno, I., Shimizu, K., Takahashi, M., & Takahara, A. (2013). Evaluation of blood pressure control using a new arterial stiffness parameter, cardio-ankle vascular index (CAVI). Current hypertension reviews, 9(1), 66-75. https://doi.org/10.2174/1573402111309010010
Miyashita, Y., Saiki, A., Endo, K., Ban, N., Yamaguchi, T., Kawana, H., Nagayama, D., Ohira, M., Oyama, T., & Shirai, K. (2009). Effects of olmesartan, an angiotensin II receptor blocker, and amlodipine, a calcium channel blocker, on Cardio-Ankle Vascular Index (CAVI) in type 2 diabetic patients with hypertension. Journal of atherosclerosis and thrombosis, 16(5), 621-626. https://doi.org/10.5551/jat.497
Matsui, Y., Eguchi, K., O'Rourke, M. F., Ishikawa, J., Miyashita, H., Shimada, K., & Kario, K. (2009). Differential effects between a calcium channel blocker and a diuretic when used in combination with angiotensin II receptor blocker on central aortic pressure in hypertensive patients. Hypertension, 54(4), 716-723. https://doi.org/10.1161/HYPERTENSIONAHA.109.131466
Rekovets, O. L., Sirenko, Y. M., Torbas, O. O., Kushnir, O. O., & Prymak, G. F. (2019). Vplyv blokatoriv retseptoriv anhiotenzynu II na zminy arterialnoho tysku pry dobovomu monitoruvanni zalezhno vid rankovoho abo vechirnoho pryiomu [Effect of angiotensin II receptor blockers on blood pressure changes at daily monitoring depending on morning or evening reception]. Ukrainskyi kardiolohichnyi zhurnal, 26(2), 32-47. [in Ukrainian]. https://doi.org/10.31928/1608-635X-2019.2.3247
Rekovets, O. L., Sirenko, Y. M., Torbas, O. O., Kushnir, C. M., & Prymak, G. F. (2019). Vplyv blokatoriv retseptoriv anhiotenzynu II na zminy ofisnoho, tsentralnoho arterialnoho tysku ta tsyrkadnist arterialnoho tysku zalezhno vid rankovoho abo vechirnoho pryiomu [Impact of Angiotensin II Receptor Blockers on Changes in Office, Central Blood Pressure and Circadian Blood Pressure in Relation to Morning or Evening Reception]. Ukrainskyi kardiolohichnyi zhurnal, 26(5), 23-32. https://doi.org/10.31928/10.31928/1608-635X-2019.5.2332
De Boer, I. H., Caramori, M. L., Chan, J., Heerspink, H., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Zoungas, S., Lytvyn, L., Craig, J. C., Tunnicliffe, D. J., Howell, M., … Rossing, P. (2020). Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment. Kidney international, 98(4), 839-848. https://doi.org/10.1016/j.kint.2020.06.024
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., Galderisi, M., Grobbee, D. E., Jaarsma, T., Kirchhof, P., Kjeldsen, S. E., Laurent, S., Manolis, A. J., Nilsson, P. M., Ruilope, L. M., Schmieder, R. E., … Task Force Members (2013). 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European heart journal, 34(28), 2159-2219. https://doi.org/10.1093/eurheartj/eht151
Shirai, K., Saiki, A., Nagayama, D., Tatsuno, I., Shimizu, K., & Takahashi, M. (2015). The Role of Monitoring Arterial Stiffness with Cardio-Ankle Vascular Index in the Control of Lifestyle-Related Diseases. Pulse, 3(2), 118-133. https://doi.org/10.1159/000431235
Nagayama, D., Saiki, A., Endo, K., Yamaguchi, T., Ban, N., Kawana, H., Ohira, M., Oyama, T., Miyashita, Y., & Shirai, K. (2010). Improvement of cardio-ankle vascular index by glimepiride in type 2 diabetic patients. International journal of clinical practice, 64(13), 1796-1801. https://doi.org/10.1111/j.1742-1241.2010.02399.x
Cheng, X. W., Okumura, K., Kuzuya, M., Jin, Z., Nagata, K., Obata, K., Inoue, A., Hirashiki, A., Takeshita, K., Unno, K., Harada, K., Shi, G. P., Yokota, M., & Murohara, T. (2009). Mechanism of diastolic stiffening of the failing myocardium and its prevention by angiotensin receptor and calcium channel blockers. Journal of cardiovascular pharmacology, 54(1), 47-56. https://doi.org/10.1097/FJC.0b013e3181ab371d
Willum-Hansen, T., Staessen, J. A., Torp-Pedersen, C., Rasmussen, S., Thijs, L., Ibsen, H., & Jeppesen, J. (2006). Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation, 113(5), 664-670. https://doi.org/10.1161/CIRCULATIONAHA.105.579342
Asmar, R., Gosse, P., Topouchian, J., N'tela, G., Dudley, A., & Shepherd, G. L. (2002). Effects of telmisartan on arterial stiffness in Type 2 diabetes patients with essential hypertension. Journal of the renin-angiotensin-aldosterone system : JRAAS, 3(3), 176-180. https://doi.org/10.3317/jraas.2002.038
Kurata, M., Okura, T., Watanabe, S., Irita, J., Enomoto, D., Johtoku, M., Miyoshi, K., Koresawa, M., Fukuoka, T., & Higaki, J. (2008). Effects of amlodipine and candesartan on arterial stiffness estimated by cardio-ankle vascular index in patients with essential hypertension: A 24-week study. Current therapeutic research, clinical and experimental, 69(5), 412-422. https://doi.org/10.1016/j.curtheres.2008.10.002
Kinouchi, K., Ichihara, A., Bokuda, K., Kurosawa, H., & Itoh, H. (2011). Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial). International journal of hypertension, 2011, 284823. https://doi.org/10.4061/2011/284823
Kinouchi, K., Ichihara, A., Sakoda, M., Kurauchi-Mito, A., Murohashi-Bokuda, K., & Itoh, H. (2010). Effects of telmisartan on arterial stiffness assessed by the cardio-ankle vascular index in hypertensive patients. Kidney & blood pressure research, 33(4), 304-312. https://doi.org/10.1159/000316724
Miyoshi, T., Doi, M., Hirohata, S., Kamikawa, S., Usui, S., Ogawa, H., Sakane, K., Izumi, R., Ninomiya, Y., & Kusachi, S. (2011). Olmesartan reduces arterial stiffness and serum adipocyte fatty acid-binding protein in hypertensive patients. Heart and vessels, 26(4), 408-413. https://doi.org/10.1007/s00380-010-0060-x
Doi, M., Miyoshi, T., Hirohata, S., Kamikawa, S., Usui, S., Kaji, Y., Sakane, K., Ogawa, H., Ninomiya, Y., & Kusachi, S. (2010). Combination therapy of calcium channel blocker and angiotensin II receptor blocker reduces augmentation index in hypertensive patients. The American journal of the medical sciences, 339(5), 433-439. https://doi.org/10.1097/MAJ.0b013e3181d658c4
Ogihara, T., Saruta, T., Shimada, K., & Kuramoto, K. (2009). A randomized, double-blind, four-arm parallel-group study of the efficacy and safety of azelnidipine and olmesartan medoxomil combination therapy compared with each monotherapy in Japanese patients with essential hypertension: the REZALT study. Hypertension research, 32(12), 1148-1154. https://doi.org/10.1038/hr.2009.163
Kurata, M., Okura, T., Watanabe, S., Irita, J., Enomoto, D., Johtoku, M., Miyoshi, K., Koresawa, M., Fukuoka, T., & Higaki, J. (2008). Effects of amlodipine and candesartan on arterial stiffness estimated by cardio-ankle vascular index in patients with essential hypertension: A 24-week study. Current therapeutic research, clinical and experimental, 69(5), 412-422. https://doi.org/10.1016/j.curtheres.2008.10.002
Munakata, M., Nagasaki, A., Nunokawa, T., Sakuma, T., Kato, H., Yoshinaga, K., & Toyota, T. (2004). Effects of valsartan and nifedipine coat-core on systemic arterial stiffness in hypertensive patients. American journal of hypertension, 17(11 Pt 1), 1050-1055. https://doi.org/10.1016/j.amjhyper.2004.06.028
Ichihara, A., Hayashi, M., Koura, Y., Tada, Y., Hirota, N., & Saruta, T. (2003). Long-term effects of intensive blood-pressure lowering on arterial wall stiffness in hypertensive patients. American journal of hypertension, 16(11 Pt 1), 959-965. https://doi.org/10.1016/s0895-7061(03)01004-5
Vaziri, N. D., Xu, Z. G., Shahkarami, A., Huang, K. T., Rodríguez-Iturbe, B., & Natarajan, R. (2005). Role of AT-1 receptor in regulation of vascular MCP-1, IL-6, PAI-1, MAP kinase, and matrix expressions in obesity. Kidney international, 68(6), 2787-2793. https://doi.org/10.1111/j.1523-1755.2005.00750.x
Sirenko, Yu. M., Polishchuk, S. A., & Radchenko, H. D. (2007). Vykorystannia suchasnykh tekhnolohii vymiriuvannia AT dlia otsinky urazhennia sudyn [Use of modern BP measurement technologies to assess vascular damage]. Praktychna anhiolohiia, (1), 35-41. [in Ukrainian].
Uehara, G., & Takeda, H. (2008). Relative effects of telmisartan, candesartan and losartan on alleviating arterial stiffness in patients with hypertension complicated by diabetes mellitus: an evaluation using the cardio-ankle vascular index (CAVI). The Journal of international medical research, 36(5), 1094-1102. https://doi.org/10.1177/147323000803600529
Ato, D. (2019). Evaluation of the calculation formulas of the cardio-ankle vascular index used in the Japanese apparatus. Vascular health and risk management, 15, 395-398. https://doi.org/10.2147/VHRM.S215709
Giudici, A., Khir, A. W., Reesink, K. D., Delhaas, T., & Spronck, B. (2021). Five years of cardio-ankle vascular index (CAVI) and CAVI0: how close are we to a pressure-independent index of arterial stiffness?. Journal of hypertension, 39(11), 2128-2138. https://doi.org/10.1097/HJH.0000000000002928
Saiki, A., Ohira, M., Yamaguchi, T., Nagayama, D., Shimizu, N., Shirai, K., & Tatsuno, I. (2020). New Horizons of Arterial Stiffness Developed Using Cardio-Ankle Vascular Index (CAVI). Journal of atherosclerosis and thrombosis, 27(8), 732-748. https://doi.org/10.5551/jat.RV17043
Namba, T., Masaki, N., Takase, B., & Adachi, T. (2019). Arterial Stiffness Assessed by Cardio-Ankle Vascular Index. International journal of molecular sciences, 20(15), 3664. https://doi.org/10.3390/ijms20153664
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 
