Drugs with Blocking Effects on the Renin-Angiotensin-Aldosterone System Do Not Improve Endothelial Dysfunction Long-term in Hypertensive Patients


Sozen A. B. , Kayacan M. S. , Tansel T. , Celebi A., Kudat H. , Akkaya V., ...More

JOURNAL OF INTERNATIONAL MEDICAL RESEARCH, vol.37, no.4, pp.996-1002, 2009 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 37 Issue: 4
  • Publication Date: 2009
  • Doi Number: 10.1177/147323000903700403
  • Title of Journal : JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
  • Page Numbers: pp.996-1002
  • Keywords: RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM-BLOCKING DRUGS, ESSENTIAL HYPERTENSION, ENDOTHELIAL DYSFUNCTION, ENDOTHELIUM-DEPENDENT VASODILATION, ENDOTHELIUM-INDEPENDENT VASODILATION, DEPENDENT VASCULAR RELAXATION, BRACHIAL-ARTERY, DOUBLE-BLIND, VASODILATION, CORONARY

Abstract

In essential hypertension, endothelial dysfunction has been documented many times and correlates with prognosis. The influence of the renin-angiotensin-aldosterone system (RAAS) on endothelial dysfunction has also been studied. The present study investigated the duration of the effects of RAAS-blocking drugs on endothelial function in 44 consecutive, never-treated, outpatients with mild to moderate hypertension. Patients (11 per group) received an angiotensin receptor blocker (ARB; irbesartan 300 mg/day or valsartan 160 mg/day) or an angiotensin-converting enzyme inhibitor (ACEi; fosinopril 10 mg/day or quinapril 20 mg/day). If target blood pressure (< 140/90 mmHg) was not achieved, 12.5 mg/day hydrochlorothiazide was added. Endothelial function, assessed by measuring brachial artery diameter, did not change significantly after 6 weeks, 1 year or 3 years of treatment in any group. Across all groups, endothelium-dependent and -independent vasodilation increased significantly after 6 weeks but, after 1 year, decreased below baseline and was at a similar level after 3 years; groups did not differ significantly. Both ACE and ARB had similar effects on endothelial function; improvement occurred at the start of treatment but was not maintained. Endothelial dysfunction may be a resistant or irreversible feature of hypertension, requiring high doses of antihypertensive drugs and above-average patient compliance.