title: Valsartan Improves Arterial Stiffness in Type 2 Diabetes Independently of Blood Pressure Lowering Angiotensin receptor blockade improves vascular compliance in healthy normotensive elderly individuals: results from a randomized double-blind placebo-controlled trial. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Efficacy of losartan and carvedilol on central hemodynamics in hypertensives: a prospective, randomized, open, blinded end point, multicenter study Effect of angiotensin receptor blockade on central haemodynamics in essential hypertension: results of a randomised trial Efficacy of various antihypertensive agents as evaluated by indices of vascular stiffness in elderly hypertensive patients. Beneficial Effects on Arterial Stiffness and Pulse-Wave Reflection of Combined Enalapril and Candesartan in Chronic Kidney Disease - A Randomized Trial Reduction of resistance artery stiffness by treatment with the AT1-receptor antagonist losartan in essential hypertension Functional Vascular Study in Hypertensive Subjects with Type 2 Diabetes Using Losartan or Amlodipine Efficacy of aliskiren and valsartan in hypertensive patients with albuminuria: a randomized parallel-group study Angiotensin II receptor blocker prevents increased arterial stiffness in patients with essential hypertension. No significant effect of angiotensin II receptor blockade on intermediate cardiovascular end points in hemodialysis patients. Changes in aortic pulse wave velocity in hypertensive postmenopausal women: comparison between a calcium channel blocker vs angiotensin receptor blocker regimen. Effect of angiotensin II on pulse wave velocity in humans is mediated through angiotensin II type 1 (AT(1)) receptors. Renal and Vascular Protective Effects of Telmisartan in Patients with Essential Hypertension Effects of Angiotensin II Type 1 Receptor Blocker on Blood Pressure Variability and Cardiovascular Remodeling in Hypertensive Patients on Chronic Peritoneal Dialysis Randomized Trial of Perindopril, Enalapril, Losartan and Telmisartan in Overweight or Obese Patients with Hypertension 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. Effects of valsartan and nifedipine coat-core on systemic arterial stiffness in hypertensive patients. Markers of Inflammation, Endothelial Activation, and Arterial Stiffness in Hypertensive Heart Disease and the Effects of Treatment: Results From the SILVHIA Study Effect of losartan on ambulatory short-term blood pressure variability and cardiovascular remodeling in hypertensive patients on hemodialysis. A randomized, double-blind study of valsartan versus metoprolol on arterial distensibility and endothelial function in essential hypertension.
abstract: Increased arterial stiffness , as estimated from aortic pulse wave velocity ( Ao-PWV ) , and albuminuria are independent predictors for cardiovascular disease in type 2 diabetes mellitus ( T2DM ) . Whether angiotensin receptor blockers ( ARBs ) , drugs with cardio-renal protective effects , improve Ao-PWV to a greater extent than other equipotent antihypertensive medications remains unclear . After a 4-week washout phase , we compared the effects of valsartan ( n=66 ) , an ARB , with that of amlodipine ( n=65 ) , a calcium channel blocker on Ao-PWV in 131 T2DM patients with pulse pressure ( PP ) ≥60 mm Hg and raised albumin excretion rate ( AER ) in a 24-week r and omized , double-blind , parallel group study . Hydrochlorothiazide ( HCTZ ) 25 mg/d was added to valsartan 160 mg and amlodipine 5 mg/od uptitrated to 10 mg/od after 4 weeks to ensure equivalent BP control . After 24 weeks brachial and central aortic PP had fallen to a similar extent with attained mean ( SD ) brachial and central PP of 61.6 ( 13.6 ) and 47.3 ( 14.1 ) mm Hg in the valsartan/HCTZ group and 61.5 ( 12.2 ) and 47.3 ( 9.9 ) mm Hg in the amlodipine group , respectively . Ao-PWV showed a significantly greater reduction , mean ( 95 % CI ) , −0.9 m/s ( −1.4 to −0.3 ) for valsartan/HCTZ compared to amlodipine ( P=0.002 ) . AER fell significantly only with Val/HCTZ from 30.8(20.4 , 46.5 ) to 18.2(12.5 , 26.3 ) mcg/min , ( P=0.01 ) with between treatment difference in favor of Val/HCTZ of −15.3mcg/min ( P<0.001 ) . Changes in AER and Ao-PWV were not correlated . Valsartan/HCTZ improves arterial stiffness and AER to a significantly greater extent than amlodipine despite similar central and brachial BP control . These 2 effects , which appear independent of each other , may explain the specific cardio-renal protective properties of ARBs The renin-angiotensin system ( RAS ) may play a role in vascular aging . The authors hypothesized that blockade of the angiotensin II type 1 receptor with an angiotensin receptor blocker in healthy elderly subjects improves vascular compliance and endothelial function .  Thirty-five healthy elderly subjects were r and omized to valsartan or placebo in a double-blind crossover study after baseline testing for pulse wave velocity , aortic augmentation index , and brachial artery flow-mediated dilation . Angiotensin II type 1 receptor blockade with valsartan improved vascular compliance but not flow-mediated dilation . Changes in pulse wave velocity with valsartan were correlated with change in central systolic blood pressure and pulse pressure and remained associated on multivariate analysis . Change in pulse wave velocity after adjusting for degree of blood pressure change , age , and sex remained correlated with assignment to the angiotensin receptor blocker but not placebo . These data suggest that angiotensin II type 1 receptor blockade improves aging-related vascular compliance without alterations in flow-mediated dilation . Mechanisms regulating compliance and endothelial function are complex and may not necessarily converge in aging Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Renin – angiotensin system ( RAS ) blockers have shown clinical outcomes superior to those of the beta (β)-blocker atenolol , despite similar reductions in the peripheral blood pressure ( BP ) , perhaps because of different impacts on central hemodynamics . However , few comparative studies of RAS blockers and newer vasodilating β-blockers have been performed . We compared the central hemodynamic effects of losartan and carvedilol in a prospect i ve , r and omized , open , blinded end point study . Of the 201 hypertensive patients enrolled , 182 ( 49.6±9.9 years , losartan group=88 and carvedilol group=94 ) were analyzed . Carotid-femoral pulse wave velocity ( cfPWV ) , aortic augmentation index ( AIx ) , AIx corrected for a heart rate ( HR ) of 75 beats per minute ( AIx@HR75 ) and central BP were measured noninvasively at baseline and after a 24-week treatment regimen with losartan or carvedilol . After 24 weeks , there were no between-group differences in the brachial BP , cfPWV , AIx@HR75 or central BP changes , except for a more favorable AIx effect with losartan . The changes in all measured metabolic and inflammatory parameters were also not significantly different between the two groups , except for uric acid . Losartan and carvedilol showed generally comparable effects on central hemodynamic indices , metabolic profile , inflammatory parameters and peripheral arterial pressure with a 24-week treatment Objective . Angiotensin-converting enzyme ( ACE ) inhibitors have been shown to lower central augmentation index ( cAI ) , an index of arterial wave reflection , more than β-blockers . We tested whether this is also true for long-term treatment with an angiotensin receptor blocker ( ARB ) . Methods . One-hundred and fifty-six subjects with essential hypertension were r and omised to treatment with either irbesartan or atenolol .  cAI and central blood pressure ( BP ) were determined by pulse wave analysis from the radial and the carotid artery after six and after 18 months treatment . Results . Peripheral and central systolic and diastolic BP were reduced to a similar extent A in the two groups . cAI was reduced with irbesartan , but increased with atenolol ( derived from the carotid artery : -6±10 vs. -4±12 % after six months , p<0.001 ; —4±12 vs. + 1±11 % after 18 months ; p=0.011 ) . Furthermore , central to peripheral pulse pressure ( PP ) amplification was unaffected by treatment with irbesartan , but decreased with atenolol . Conclusions . Although treatment with irbesartan and atenolol  similarly decreased peripheral and central BP , only treatment with irbesartan had beneficial effects on arterial wave reflection and preserved PP amplification . These haemodynamic effects may at least partly explain the reported differential effects of ARB versus β-blocker treatment on cardiovascular mortality in patients with essential hypertension When observed in elderly hypertensive patients , increased pulse pressure ( PP ) and arterial stiffness are known to be independent risk factors for cardiovascular diseases . Increased systolic blood pressure ( SBP ) leads to left ventricular hypertrophy , while decreased diastolic blood pressure ( DBP ) results in decreased coronary circulation . It is known that increased arterial stiffness is the major cause of increased PP . Thus basic morbid states of cardiac failure or ischemic heart diseases are more likely to develop in elderly hypertensive patients with increased PP and arterial stiffness , and there is need of antihypertensive drugs that decrease these effects in elderly hypertensives . In this study , we compared the effects of an angiotensin-receptor blocker ( ARB : valsartan ) , an angiotensin-converting enzyme inhibitor ( ACE-I : temocapril ) , and long-acting Ca antagonists ( L- and N-type Ca channel blocker : cilnidipine ; and L-type Ca channel blocker : nifedipine CR ) on PP and arterial stiffness measured by pulse wave velocity in elderly hypertensive patients for 3 months . The ARB yielded the largest reductions in PP and brachial-ankle pulse wave velocity ( baPWV ) , followed by the ACE-I and L- and N-type Ca channel blocker , while the L-type Ca channel blocker yielded no improvement . The effects on arterial stiffness and PP thus varied among the drug characteristics . Although ARB achieved the largest reduction in baPWV , this decrease was not associated with any reductions in PP , SBP , DBP , or mean blood pressure , as were the baPWV-decreases achieved by the other drugs , suggesting that ARB may further reduce the risk of arteriosclerosis in elderly hypertensive patients by decreasing arterial stiffness in addition to its antihypertensive effect Background Cardiovascular disease ( CVD ) is highly prevalent in patients with chronic kidney disease ( CKD ) . Inhibition of the renin-angiotensinsystem ( RAS ) in hypertension causes differential effects on central and brachial blood pressure ( BP ) , which has been translated into improved outcome . The objective was to examine if a more complete inhibition of RAS by combining an angiotensin converting enzyme inhibitor ( ACEI ) and an angiotensin receptor antagonist ( ARB ) compared to monotherapy has an additive effect on central BP and pulse-wave velocity ( PWV ) , which are known markers of CVD . Methods Sixty-seven CKD patients ( mean GFR 30 , range 13–59 ml/min/1.73 m2 ) participated in an open r and omized study of 16 weeks of monotherapy with either enalapril or c and esartan followed by 8 weeks of dual blockade aim ing at a total dose of 16 mg c and esartan and 20 mg enalapril o.d . Pulse-wave measurements were performed at week 0 , 8 , 16 and 24 by the SphygmoCor device . Results Significant additive BP independent reductions were found after dual blockade in aortic PWV ( −0.3 m/s , P<0.05 ) and in augmentation index ( −2 % , P<0.01 ) compared to monotherapy . Furthermore pulse pressure amplification was improved ( P<0.05 ) and central systolic BP reduced ( −6 mmHg , P<0.01 ) . Conclusions Dual blockade of the RAS result ed in an additive BP independent reduction in pulse-wave reflection and arterial stiffness compared to monotherapy in CKD patients . Trial Registration Clinical trial.gov In spontaneously hypertensive rats resistance artery structure , endothelial dysfunction and geometry-independent wall stiffness were reduced by an angiotensin AT1-receptor antagonist . In previous studies of human hypertension , interruption of the renin-angiotensin system corrected small artery structure and endothelial dysfunction , whereas the β-blocker atenolol did not . We hypothesized that the AT1R antagonist losartan , but not the β-blocker atenolol , would reduce stiffness of gluteal subcutaneous small arteries in essential hypertensive patients . Seventeen untreated mild essential hypertensive patients ( 47±2years ; 75 % male ) were r and omly assigned in double-blind fashion to losartan or atenolol treatment for one year . Small , resistance size arteries were studied on pressurized myographs . Blood pressure ( mmHg ) was reduced ( p<0.01 ) from 145±4/101±2 and 147±6/98±2 to 128±4/86±2 and 131±3/84±1 by losartan and atenolol , respectively . The media/lumen ratio of small arteries was unaffected by atenolol ( 8.3±0.3 % before and 8.8±0.5 % after treatment ) . In contrast , losartan reduced media/lumen ratio from 8.4±0.4 % to 6.7±0.3 % ( p<0.01 ) . Whereas isobaric elastic modulus was unaffected by either treatment , geometry-independent stiffness ( slope of elastic modulus vs. stress ) was reduced from 9.7±1.2 to 6.1±0.9 ( P<0.05 ) under losartan treatment , but was unchanged by atenolol ( 8.2±1.3 to 7.8±0.6 ) . In conclusion , treatment with losartan reduced stiffness and structural alterations of subcutaneous resistance arteries of previously untreated essential hypertensive patients , whereas atenolol failed to do so Background Antihypertensive drugs are used to control blood pressure ( BP ) and reduce macro- and microvascular complications in hypertensive patients with diabetes . Objectives The present study aim ed to compare the functional vascular changes in hypertensive patients with type 2 diabetes mellitus after 6 weeks of treatment with amlodipine or losartan . Methods Patients with a previous diagnosis of hypertension and type 2 diabetes mellitus were r and omly divided into 2 groups and evaluated after 6 weeks of treatment with amlodipine ( 5 mg/day ) or losartan ( 100 mg/day ) . Patient evaluation included BP measurement , ambulatory BP monitoring , and assessment of vascular parameters using applanation tonometry , pulse wave velocity ( PWV ) , and flow-mediated dilation ( FMD ) of the brachial artery . Results A total of 42 patients were evaluated ( 21 in each group ) , with a predominance of women ( 71 % ) in both groups . The mean age of the patients in both groups was similar ( amlodipine group : 54.9 ± 4.5 years ; losartan group : 54.0 ± 6.9 years ) , with no significant difference in the mean BP  [ amlodipine group : 145 ± 14 mmHg ( systolic ) and 84 ± 8 mmHg ( diastolic ) ; losartan group : 153 ± 19 mmHg ( systolic ) and 90 ± 9 mmHg ( diastolic ) ] . The augmentation index ( 30 % ± 9 % and 36 % ± 8 % , p = 0.025 ) and augmentation pressure ( 16 ± 6 mmHg and 20 ± 8 mmHg , p = 0.045 ) were lower in the amlodipine group when compared with the losartan group . PWV and FMD were similar in both groups . Conclusions Hypertensive patients with type 2 diabetes mellitus treated with amlodipine exhibited an improved pattern of pulse wave reflection in comparison with those treated with losartan . However , the use of losartan may be associated with independent vascular reactivity to the pressor effect Introduction : Blockade of the renin-angiotensin system ( RAS ) is a critical approach to the management of hypertension , especially in proteinuric patients . It is well proven that the direct renin inhibitor aliskiren shows comparable clinical efficacy to the angiotensin II receptor blocker valsartan on blood pressure control and albuminuria . However , there is only limited data on the h and -to-h and effectiveness of these two RAS blockers in improving arterial stiffness . We tested whether aliskiren or valsartan would improve arterial stiffness in hypertensive patients with albuminuria who are already on antihypertensive therapy . Material and methods : Thirty-four patients with hypertension and albuminuria < 1 g , after a wash-out period of three weeks , were r and omized to aliskiren or valsartan in a 24-week r and omized parallel-group study . Results : A nonsignificant difference in blood pressure was seen between the two treatment groups . Albuminuria was significantly reduced in both groups ( 56 % for the aliskiren group , p < 0.05 , and 38 % for the valsartan group , p < 0.05 ) . Only valsartan but not aliskiren significantly reduced carotid-femoral pulse wave velocity ( –1.1 ± 0.8 m/s ( p = 0.02 ) for valsartan and + 0.1 ± 0.7 m/s ( ns ) for aliskiren ) . Conclusion : The results of our study showed that valsartan  improves arterial stiffness to a significantly greater extent than aliskiren , despite a similar antihypertensive and antiproteinuric effect BACKGROUND High pulse wave velocity ( PWV ) is related to cardiovascular risk in essential hypertension ( EHT ) . It is reported that short-term treatment with an angiotensin II receptor blocker ( ARB ) decreases PWV , as well as blood pressure ( BP ) , and increases the serum adiponectin , known as an adipocytokine , which has an anti-atherosclerotic effect . However , it is not known whether long-term treatment with ARB prevents the increase in PWV independently of the reduction of BP , and whether adiponectin is related to the chronic effect of ARB on PWV . METHODS AND RESULTS In order to examine the short-term effect of ARB on PWV , 9 subjects with EHT had PWV measured before and after treatment with an ARB for 1 month . The treatment significantly reduced PWV and BP . For evaluation of the long-term effect of ARB therapy , 56 consecutive subjects with EHT who were already taking anti-hypertensive drugs other than an angiotensin-converting enzyme inhibitor had their PWV measured . We divided the EHT subjects into 2 groups : ( 1 ) the  ARB group ( EHT treated with an ARB for at least 6 months )  and ( 2 ) the control group ( EHT treated with anti-hypertensive drugs other than an ARB )  . Although there was no significant difference between the 2 groups in BP , age or body mass index , the PWV value in the ARB group was significantly lower than that in the control group . Moreover , the serum adiponectin concentration in the ARB group was significantly higher than that in the control group . CONCLUSIONS Long-term treatment with ARB inhibits the progression of arterial stiffness independent of BP reduction . One of the mechanisms may be related to the increased serum adiponectin concentration after treatment with an ARB Agents blocking the renin-angiotensin-aldosterone system are frequently used in patients with end-stage renal disease , but whether they exert beneficial cardiovascular effects is unclear . Here the long-term effects of the angiotensin II receptor blocker , irbesartan , were studied in hemodialysis patients in a double-blind r and omized  placebo-controlled 1-year intervention trial using a predefined systolic blood pressure target of 140 mm Hg ( SAFIR study ) . Each group of 41 patients did not differ in terms of age , blood pressure , comorbidity , antihypertensive treatment , dialysis parameters , and residual renal function .  Brachial blood pressure decreased significantly in both groups , but there was no significant difference between placebo and irbesartan .  Use of additional antihypertensive medication , ultrafiltration volume , and dialysis dosage were not different . Intermediate cardiovascular end points such as central aortic blood pressure , carotid-femoral pulse wave velocity , left ventricular mass index , N-terminal brain natriuretic prohormone , heart rate variability , and plasma catecholamines were not significantly affected by irbesartan treatment . Changes in systolic blood pressure during the study period significantly correlated with changes in both left ventricular mass and arterial stiffness . Thus , significant effects of irbesartan on intermediate cardiovascular end points beyond blood pressure reduction were absent in hemodialysis patients Postmenopausal women are at greater risk for hypertension-related cardiovascular disease .  Antihypertensive therapy may help alleviate arterial stiffness that represents a potential modifiable risk factor of hypertension . This r and omized controlled study investigated the difference between an angiotensin receptor blocker and a calcium channel blocker in reducing arterial stiffness . Overall , 125 postmenopausal hypertensive women ( age , 61.4 ± 6 years ; systolic blood pressure/diastolic blood pressure [ SBP/DBP ] , 158 ± 11/92 ± 9 mm Hg ) were r and omized  to valsartan 320 mg ± hydrochlorothiazide ( HCTZ ) ( n = 63 ) or amlodipine 10 mg ± HCTZ ( n = 62 ) . The primary outcome was carotid-to-femoral pulse wave velocity ( PWV ) changes after 38 weeks of treatment . Both treatments lowered peripheral blood pressure ( BP ) ( -22.9/-10.9 mm Hg for valsartan and -25.2/-11.7 mm Hg for amlodipine , P = not significant ) and central BP ( -15.7/-7.6 mm Hg for valsartan and -19.2/-10.3 mm Hg for amlodipine , P<.05 for central DBP ) . Both treatments similarly reduced the carotid-femoral PWV ( -1.9 vs -1.7 m/s ; P = not significant ) . Amlodipine was associated with a higher incidence of peripheral edema compared with the valsartan group ( 77 % vs 14 % , P<.001 ) . BP lowering in postmenopausal women led to a reduction in arterial stiffness as assessed by PWV measurement . Both regimens reduced PWV to a similar degree after 38 weeks of treatment despite differences in central BP lowering , suggesting that the effect of valsartan on PWV is mediated through nonhemodynamic effects The objective of this study was to examine the effect of angiotensin II ( Ang II ) and angiotensin II type 1 ( AT(1 ) ) receptor blockade on pulse wave velocity ( PWV ) in healthy humans . We studied nine young male volunteers in a double-blind r and omised crossover design . Carotid-femoral PWV ( an index of arterial stiffness ) was measured by using a Complior machine . Subjects were previously treated for 3 days with once-daily dose of either a placebo or valsartan 80 mg . On the third day , they were infused with either placebo or 5 ng/kg/min of Ang II over 30 min . Subjects thus received placebo capsule + placebo infusion ( P ) , valsartan + placebo infusion ( V ) , placebo + Ang II infusion ( A ) , and valsartan + Ang II infusion ( VA ) combinations . Heart rate ( HR ) , blood pressure and PWV were recorded at baseline and then every 10 min during infusion and once after the end of infusion . There were significant increases in systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) and mean arterial pressure ( MAP ) with A compared with P ( P = 0.002 , P = 0.002 , P = 0.001 respectively ) . These rises in blood pressure were completely blocked by valsartan . A significant rise in PWV by A was seen compared with P ( 8.38 + /- 0.24 vs 7.48 + /- 0.24 m/sec , P = 0.013 ) and was completely blocked by valsartan ; VA compared with P ( 7.27 + /- 0.24 vs 7.48 + /- 0.24 m/sec , P = NS ) . Multiple linear regression analysis showed that blockade of Ang II induced increase in blood pressure by valsartan contributed to only 30 % of the total reduction in Ang II induced rise in PWV ( R(2 ) = 0.306 ) . The conclusions were that valsartan completely blocks the effect of Ang II on PWV . The effect of Ang II on PWV is mediated through AT(1)receptors . Reduction in PWV by Ang II antagonist is not fully explained by its pressure lowering effect of Ang II and may be partially independent of its effect on blood pressure It is known that the angiotensin receptor blockers ( ARBs ) have organ protective effects in patients with heart failure or renal impairment . Several studies have revealed that the ARB telmisartan has an organ protective effect , but there have been few studies directly comparing the effects of telmisartan and calcium antagonists , since most clinical studies on telmisartan have been conducted in treated patients or patients on combination therapy . The present study was conducted to compare the renal and vascular protective effects of telmisartan monotherapy and calcium antagonist monotherapy in untreated hypertensive patients . Forty-three patients with untreated essential hypertension were r and omized to receive amlodipine ( n=22 ) or telmisartan ( n=21 ) , which were respectively administered at doses of 5 mg and 40 mg once daily in the morning for 24 weeks . The patients were examined before and after treatment to assess changes of renal function , flow-mediated dilation ( a parameter of vascular endothelial function ) , and brachial-ankle pulse wave velocity ( baPWV ; a parameter of arteriosclerosis ) . Before treatment , there were no significant differences in these parameters between groups . The decreases of urinary albumin excretion and baPWV , and the increase of flow-mediated dilation were significantly greater in the telmisartan group than the amlodipine group , while the antihypertensive effects were not significantly different between the two groups . In conclusion , these results suggest that telmisartan is more effective at protecting renal function and vascular endothelial function , and at improving arteriosclerosis than the calcium channel blocker in patients with essential hypertension Aims : In this study , we examined whether addition of an angiotensin II type 1 receptor blocker ( ARB ) , c and esartan or valsartan , to conventional antihypertensive treatment could improve blood pressure ( BP ) variability in hypertensive patients on peritoneal dialysis . Methods : 45 hypertensive patients on chronic peritoneal dialysis therapy were r and omly assigned to the ARB treatment groups either by c and esartan ( n = 15 ) or valsartan ( n = 15 ) , or the control group ( n = 15 ) . At baseline and 6 months after the treatment , 24-hour ambulatory BP monitoring , echocardiography  , and measurement of brachial-ankle pulse wave velocity ( baPWV ) were performed . Results : After the 6 months of treatment , 24-hour ambulatory BP values were similarly decreased in both the control group and ARB groups . However , short-term BP variability assessed on the basis of the st and ard deviation of 24-hour ambulatory BP was significantly decreased in the ARB groups , but remained unchanged in the control group . Furthermore , parameters of cardiovascular remodeling assessed by natriuretic peptides , echocardiography , and baPWV were significantly improved in the ARB groups but not in the control group . Conclusion : ARB treatment and control antihypertensive treatment similarly controlled 24-hour ambulatory BP values in hypertensive patients on peritoneal dialysis . However , ARB treatment is beneficial for the suppression of pathological cardiovascular remodeling with a decrease in BP variability Background and Objectives Obesity exacerbates hypertension and stimulates the renin – angiotensin – aldosterone system ( RAAS ) . Full-dose RAAS inhibition could be a therapeutic option in overweight or obese patients with hypertension . This study compared four RAAS inhibitors at full therapeutic doses to determine their effect on blood pressure ( BP ) and cardiovascular risk factors in these patients . Methods We conducted a 24-week , single-blind , r and omized , parallel-group study in 120 overweight or obese patients ( body mass index ≥27 kg/m2 ) with hypertension , aged 18–60 years . The primary endpoint was the change in mean 24-h systolic BP and diastolic BP from baseline to study end . Central BP , arterial stiffness , and metabolic and cardiac indices were also investigated . Patients were r and omly allocated to perindopril 10 mg/day , enalapril 20 mg/day , losartan 100 mg/day or telmisartan 80 mg/day . Nonpharmacological interventions were also recommended . Results Reductions in mean 24-h systolic BP ( and diastolic BP ) were all significant ( p < 0.05 versus baseline ) for perindopril , enalapril , losartan and telmisartan  : systolic BP −22 , −11 , −12 and −15 mmHg , respectively ; ( and diastolic BP −13 , −6 , −13 and −12 mmHg , respectively ) . Aortic elasticity improved with perindopril and telmisartan . Perindopril was associated with the greatest reductions in central aortic BP and leptin levels [ 30 % versus 2 % , 7 % and 14 % with enalapril , losartan and telmisartan , respectively ( all p < 0.05 versus perindopril ) ] . Reductions in other BP , echocardiographic , metabolic and anthropometric parameters occurred with all treatments . Conclusion Full-dose RAAS inhibition , particularly with perindopril , effectively reduces BP , improves arterial structure and regulates cardiovascular risk factors in overweight or obese patients with hypertension AIM Recently , a novel device for measuring the cardio-ankle vascular index ( CAVI ) as an arterial stiffness parameter has been developed . In this study , we evaluated the effect of angiotensin II receptor blocker ( ARB ) and calcium channel ( Ca ) blocker on CAVI in type 2 diabetic patients with hypertension . METHODS Seventy type 2 diabetes mellitus patients with hypertension were enrolled and r and omly divided into two groups . One group was administered olmesartan medoxomil 20 mg/day [ DOSAGE ERROR CORRECTED ] for 12 months ( ARB group ) , and the other group was administered amlodipine besilate 5 mg/day for 12 months ( Ca blocker group ) . RESULTS In the ARB group , a significant decrease in CAVI was observed after 12 months ; however , no significant change in CAVI was observed in the Ca blocker group although changes in blood pressure were almost the same . By simple regression analyses , CAVI changes correlated positively with 8-OHdG changes . CONCLUSIONS Olmesartan , an ARB , improved arterial stiffness more than amlodipine , and this effect might be due to not only the blood pressure-lowering effect but also to reducing the potential of oxidative stress recognized in olmesartan BACKGROUND The aim of this study was to compare the effects of long-term antihypertensive treatment on brachial-ankle pulse wave velocity ( PWV ) , a marker of systemic arterial stiffness , between angiotensin II receptor blocker valsartan and long-acting calcium channel blocker nifedipine coat-core . METHODS Forty-one patients ( 54 + /- 3 years of age , 20 men and 21 women ) with essential hypertension ( 155 + /- 3/95 + /- 3 mm Hg ) were r and omly allocated to the treatment with valsartan ( 80 mg once daily ) or nifedipine coat-core ( 20 mg once daily ) . Brachial-ankle PWV and 24-h ambulatory blood pressures ( BP ) were measured before and 3 months after treatment . RESULTS Baseline data did not differ between the valsartan and nifedipine groups . The PWV also was similar between the groups ( 1669 + /- 65 v 1622 + /- 64 cm/sec ) . Three months of treatment similarly reduced resting systolic and diastolic BP ( nifedipine , -18.4 + /- 4.2/-11.9 + /- 2.7 mm Hg ; valsartan , - 17.4 + /- 3.3/-9.8 + /- 2.1 mm Hg , all P < .001 ) . The PWV was significantly reduced compared with baseline values in the valsartan group ( -195 + /- 42 cm/sec , P < 0.001 ) but not in the nifedipine group ( -69 + /- 40 cm/sec , NS ) . The 24-h mean heart rate increased in the nifedipine group but remained unchanged in the valsartan group , although BP were similarly lowered for 24 h. A tachycardic response was associated with an increase or lesser reduction in PWV in a group treated with nifedipine ( r = 0.584 , P < .01 ) . CONCLUSIONS These data suggest that long-term treatment with valsartan could reduce arterial stiffness better than nifedipine-coat core . The favorable vascular effect of valsartan was due in part to its nonhypotensive effect . The expected decrease in arterial stiffness may be offset by reflex sympathetic activation in some patients treated with nifedipine Abstract : We assessed the contribution of blood pressure ( BP ) , inflammation , and endothelial activation to the development of structural vascular and cardiac changes in hypertension . Furthermore , the effects of antihypertensive therapy were studied . We studied 114 patients with hypertension and left ventricular hypertrophy and 38 matched hypertensive subjects without cardiac hypertrophy and 38 normotensive subjects . The group with hypertension and cardiac hypertrophy were r and omized to treatment with an angiotensin receptor blocker ( irbesartan ) or a beta-adrenergic receptor blocker ( atenolol ) for 48 weeks . Markers of inflammation ( high-sensitive C-reactive protein , interleukin-6 , leukocyte counts ) , vascular function ( ambulatory aortic stiffness index , arterial compliance , and pulse pressure ) , and endothelial activation ( E-selectin , intracellular adhesion molecule-1 , vascular adhesion molecule-1 ) were assessed . Markers of inflammation and arterial stiffness were lowest in the normotensive group and highest in patients with hypertensive heart disease ; endothelial markers were similar between groups . Inflammation was independently related to BP . Markers of arterial stiffness were independently related to BP and to a lesser extent to left ventricular mass . Antihypertensive treatment improved arterial compliance ; inflammatory and endothelial markers remained unchanged . In conclusion , markers of inflammation and arterial stiffness are independently related to BP . Antihypertensive therapy seems to improve arterial stiffness , but effects on markers of inflammation and endothelial activation are small OBJECTIVE Previous studies have shown increases in ambulatory short-term blood pressure ( BP ) variability to be related to cardiovascular disease . In this study , we examined whether an angiotensin II type 1 receptor blocker losartan would improve ambulatory short-term BP variability in hypertensive patients on hemodialysis . METHODS Forty hypertensive patients on hemodialysis therapy were r and omly assigned to the losartan treatment group ( n=20 ) or the control treatment group ( n=20 ) . At baseline and 6 and 12 months after the treatment ,  24-h ambulatory BP monitoring  was performed .  Echocardiography  and  measurements of brachial-ankle pulse wave velocity ( baPWV ) and biochemical parameters were also performed before and after therapy . RESULTS After 6- and 12-months of treatment , nighttime short-term BP variability , assessed on the basis of the coefficient of variation of ambulatory BP , was significantly decreased in the losartan group , but remained unchanged in the control group . Compared with the control group , losartan significantly decreased left ventricular mass index ( LVMI ) , baPWV , and the plasma levels of brain natriuretic peptide and advanced glycation end products ( AGE ) . Furthermore , multiple regression analysis showed significant correlations between changes in LVMI and changes in nighttime short-term BP variability , as well as between changes in LVMI and changes in the plasma levels of AGE . CONCLUSION These results suggest that losartan is beneficial for the suppression of pathological cardiovascular remodeling though its inhibitory effect on ambulatory short-term BP variability during nighttime BACKGROUND Antihypertensive drugs may have differential , pressure-independent effects on hypertension-associated alterations of arterial function . We compared the effects of a 12-week therapy with the AT(1)-receptor antagonist valsartan ( Val ) versus the beta-blocker metoprolol ( Met ) on arterial stiffness and endothelial function in mildly hypertensive patients at rest and during generalized sympathetic stimulation . METHODS Sixty-eight patients ( 37 male , 31 female , 46 + /- 6 years ) were r and omized to Val ( 80 - 160 mg/d ) or Met ( 50 - 100 mg/d ) . Effects of therapy on endothelial function , brachial and carotid artery distensibility coefficients , pulse wave velocity , carotid intima-media thickness and elastic modulus were assessed at rest and during the cold pressor test . RESULTS Fifty-two patients were available for per protocol analysis . Blood pressure was comparably reduced in both treatment groups . Effects on endothelial function and large artery elastic wall properties did not differ significantly between the two antihypertensive treatment regimens . Trends did not differ significantly between groups for any parameter including carotid intima-media thickness and elastic modulus . CONCLUSION Short-term treatment with Val and Met had similar effects on large artery functional vessel wall properties in a population of mildly hypertensive patients
target: The effect of ARB on the improvement of the PWV level is not superior to other types of antihypertensive agents , but ARB is superior to other types of antihypertensive agents for improving the AI level .
  Overall , to improve of arterial stiffness , ARB maybe is superior to other antihypertensive agents
background: BACKGROUND This system review and meta- analysis was conducted to systematic ally review and analyze the clinical benefits of different antihypertensive agents in improving arterial stiffness in hypertensive patients .