Document Detail


Effect of crossing over hypertensive patients from a beta-blocker to an angiotensin receptor antagonist on resistance artery structure and on endothelial function.
MedLine Citation:
PMID:  11791028     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Treatment of essential hypertensive patients with an AT1 angiotensin receptor antagonist has previously resulted in correction of resistance artery structure and endothelial function, whereas in a parallel group treated with the beta-blocker atenolol there was no improvement of altered vascular structure and function. To test the hypothesis that patients previously treated with atenolol could present improvement of vascular structure and endothelial function if they were subjected to blockade of the renin-angiotensin system, we crossed over hypertensive patients that had been randomized to treatment with the beta-blocker atenolol to treatment with the AT1 antagonist irbesartan, and studied small artery structure and endothelial function before and after treatment. METHODS: Eleven essential hypertensive patients (51 +/- 2 years, range 38-65; 75% male) that had previously been randomized to treatment with atenolol and treated for 1 year with good blood pressure control, were crossed over to treatment with the AT1 antagonist irbesartan for 1 year. Small resistance arteries were dissected from gluteal subcutaneous biopsies that were performed before and after 1 year of treatment. The structure and endothelial function of the resistance arteries were studied on a pressurized myograph. RESULTS: Blood pressure control (129 +/- 3.3/85 +/- 1.8 mmHg) was identical to that achieved previously with atenolol (131 +/- 3.3/84 +/- 1.1 mmHg). Following 1 year of treatment, the arterial media width to lumen ratio (M/L) of resistance arteries (lumen diameter, 150-350 microm), which had remained unchanged under atenolol treatment, decreased from 8.44 +/- 0.45% when patients were on atenolol, to 6.46 +/- 0.30%, P < 0.01, when patients received irbesartan. Maximal acetylcholine-induced endothelium-dependent relaxation was 81.1 +/- 4.1% when patients were on atenolol, unchanged from before starting treatment with the beta-blocker, and was normalized by irbesartan (to 94.8 +/- 2.0%, P < 0.01). CONCLUSION: Crossing over essential hypertensive patients with well-controlled blood pressure from the beta-blocker atenolol to the AT1 receptor antagonist irbesartan resulted in correction of previously persistently altered vascular structure and endothelial function, suggesting a structural and endothelial vascular protective effect of antihypertensive treatment with the AT1 receptor antagonist.
Authors:
Ernesto L Schiffrin; Jeong Bae Park; Qian Pu
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  20     ISSN:  0263-6352     ISO Abbreviation:  J. Hypertens.     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-15     Completed Date:  2002-04-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  71-8     Citation Subset:  IM    
Affiliation:
Multidisciplinary Research Group on Hypertension, Clinical Research Institute of Montréal, University of Montréal, 110 Pine Avenue West, Montréal, Québec, Canada H2W 1R7. schiffe@ircm.qc.ca
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MeSH Terms
Descriptor/Qualifier:
Acetylcholine / therapeutic use
Adrenergic beta-Antagonists / therapeutic use*
Adult
Aged
Antihypertensive Agents / therapeutic use
Arteries / drug effects*
Atenolol / therapeutic use
Biphenyl Compounds / antagonists & inhibitors,  therapeutic use
Blood Pressure / drug effects
Cross-Over Studies
Diuretics
Dose-Response Relationship, Drug
Double-Blind Method
Echocardiography
Endothelium, Vascular / drug effects*,  physiology*
Female
Heart Rate / drug effects
Humans
Hydrochlorothiazide / therapeutic use
Hypertension / complications,  drug therapy*
Hypertrophy, Left Ventricular / complications,  drug therapy,  ultrasonography
Male
Middle Aged
Nitroprusside / therapeutic use
Receptors, Angiotensin / antagonists & inhibitors*,  therapeutic use*
Sensitivity and Specificity
Sodium Chloride Symporter Inhibitors / therapeutic use
Tetrazoles / antagonists & inhibitors,  therapeutic use
Treatment Outcome
Vascular Resistance / drug effects*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 0/Biphenyl Compounds; 0/Diuretics; 0/Receptors, Angiotensin; 0/Sodium Chloride Symporter Inhibitors; 0/Tetrazoles; 138402-11-6/irbesartan; 15078-28-1/Nitroprusside; 29122-68-7/Atenolol; 51-84-3/Acetylcholine; 58-93-5/Hydrochlorothiazide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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