P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY
Objectives: To study whether inhibition of the renin-angiotensin-aldosterone system has effects on vascular function beyond blood pressure (BP) reduction alone. Methods: Mild-to-moderate hypertensive patients (age 54±12 years, 34% women) were randomized double-blind to ramipril (10 mg od, n=33) or...
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| Format: | Article |
| Language: | English |
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BMC
2015-11-01
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| Series: | Artery Research |
| Online Access: | https://www.atlantis-press.com/article/125930583/view |
| _version_ | 1811300709854871552 |
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| author | Andreas Jekell* Majid Kalani Thomas Kahan |
| author_facet | Andreas Jekell* Majid Kalani Thomas Kahan |
| author_sort | Andreas Jekell* |
| collection | DOAJ |
| description | Objectives: To study whether inhibition of the renin-angiotensin-aldosterone system has effects on vascular function beyond blood pressure (BP) reduction alone.
Methods: Mild-to-moderate hypertensive patients (age 54±12 years, 34% women) were randomized double-blind to ramipril (10 mg od, n=33) or doxazosin (8 mg od, n=28) for 12 weeks. Central BP, pulse wave velocity (PWV), and augmentation index (AIx) were assessed by applanation tonometry (SphygmoCor, AtCor Medical). Endothelial function was studied by forearm post-ischemic flow mediated vasodilatation (FMD) and pulse wave analysis with beta 2-adrenoceptor-agonist stimulation, and by skin microcirculation iontophoresis (acetylcholine and sodium nitroprusside).
Results: Baseline central and brachial BP were 140/89 and 148/89 mmHg, carotid and brachial pulse pressures 51 and 60 mmHg, carotid-femoral and carotid-radial PWV 8.8 and 8.9 m/s, and AIx 30.1%. Treatment induced reductions (means±SEM) in central and brachial BP (−7.9±1.1/−6.6±1.1 and −6.0±1.0/−6.8±1.1%; all P<0.001) with greater reductions in central BP (all P<0.05), carotid/brachial pulse pressure ratio (−4.7±1.7%; P<0.01), carotid-radial PWV (−2.9±2.0%; P<0.05), and AIx (−15.9±4.5%; P<0.01), but did not affect carotid-femoral PWV or carotid-femoral/carotid-radial PWV ratios. Ramipril induced greater changes than doxazosin in central and brachial systolic BP (−9.8±1.4 vs −5.4±1.6 and −7.9±1.3 vs −3.8±1.4%; all P<0.05) but central/brachial BP ratio reductions were similar. All endothelial function indices suggested normal endothelial function (eg FMD 5.5±4.1%, reflection index 0.79±0.06) with no treatment effects.
Conclusions: Angiotensin converting enzyme-inhibition and alpha 1-adrenoceptor-blockade similarly reduce central BP more than brachial BP and improve indices of aortic stiffness. Evidence of endothelial dysfunction might require more advanced stages of hypertensive disease. |
| first_indexed | 2024-04-13T06:56:20Z |
| format | Article |
| id | doaj.art-d1250eb7deed43bab5dfa083f12db1a2 |
| institution | Directory Open Access Journal |
| issn | 1876-4401 |
| language | English |
| last_indexed | 2024-04-13T06:56:20Z |
| publishDate | 2015-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Artery Research |
| spelling | doaj.art-d1250eb7deed43bab5dfa083f12db1a22022-12-22T02:57:15ZengBMCArtery Research1876-44012015-11-011210.1016/j.artres.2015.10.241P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDYAndreas Jekell*Majid KalaniThomas KahanObjectives: To study whether inhibition of the renin-angiotensin-aldosterone system has effects on vascular function beyond blood pressure (BP) reduction alone. Methods: Mild-to-moderate hypertensive patients (age 54±12 years, 34% women) were randomized double-blind to ramipril (10 mg od, n=33) or doxazosin (8 mg od, n=28) for 12 weeks. Central BP, pulse wave velocity (PWV), and augmentation index (AIx) were assessed by applanation tonometry (SphygmoCor, AtCor Medical). Endothelial function was studied by forearm post-ischemic flow mediated vasodilatation (FMD) and pulse wave analysis with beta 2-adrenoceptor-agonist stimulation, and by skin microcirculation iontophoresis (acetylcholine and sodium nitroprusside). Results: Baseline central and brachial BP were 140/89 and 148/89 mmHg, carotid and brachial pulse pressures 51 and 60 mmHg, carotid-femoral and carotid-radial PWV 8.8 and 8.9 m/s, and AIx 30.1%. Treatment induced reductions (means±SEM) in central and brachial BP (−7.9±1.1/−6.6±1.1 and −6.0±1.0/−6.8±1.1%; all P<0.001) with greater reductions in central BP (all P<0.05), carotid/brachial pulse pressure ratio (−4.7±1.7%; P<0.01), carotid-radial PWV (−2.9±2.0%; P<0.05), and AIx (−15.9±4.5%; P<0.01), but did not affect carotid-femoral PWV or carotid-femoral/carotid-radial PWV ratios. Ramipril induced greater changes than doxazosin in central and brachial systolic BP (−9.8±1.4 vs −5.4±1.6 and −7.9±1.3 vs −3.8±1.4%; all P<0.05) but central/brachial BP ratio reductions were similar. All endothelial function indices suggested normal endothelial function (eg FMD 5.5±4.1%, reflection index 0.79±0.06) with no treatment effects. Conclusions: Angiotensin converting enzyme-inhibition and alpha 1-adrenoceptor-blockade similarly reduce central BP more than brachial BP and improve indices of aortic stiffness. Evidence of endothelial dysfunction might require more advanced stages of hypertensive disease.https://www.atlantis-press.com/article/125930583/view |
| spellingShingle | Andreas Jekell* Majid Kalani Thomas Kahan P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY Artery Research |
| title | P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY |
| title_full | P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY |
| title_fullStr | P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY |
| title_full_unstemmed | P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY |
| title_short | P3.17 THE EFFECTS OF ALPHA 1-ADRENOCEPTOR-BLOCKADE BY DOXAZOSIN AND ANGIOTENSIN CONVERTING ENZYME-INHIBITION BY RAMIPRIL ON CENTRAL AND BRACHIAL BLOOD PRESSURE AND VASCULAR REACTIVITY IN MILD-TO-MODERATE HYPERTENSION: THE DOXAZOSIN RAMIPRIL STUDY |
| title_sort | p3 17 the effects of alpha 1 adrenoceptor blockade by doxazosin and angiotensin converting enzyme inhibition by ramipril on central and brachial blood pressure and vascular reactivity in mild to moderate hypertension the doxazosin ramipril study |
| url | https://www.atlantis-press.com/article/125930583/view |
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