P1.10 BENEFICIAL EFFECT OF SEQUENTIAL NEPHRON BLOCKADE OF CENTRAL PRESSURE AND LARGE ARTERY REMODELLING IN RESISTANT HYPERTENSION

DOI

10.1016/j.artres.2013.10.041How to use a DOI?

Abstract

Objective: We have previously shown that combined renin-angiotensin system blockade (RB) was less effective than sequential-nephron blockade (SNB) for controlling BP in resistant hypertension (RH). Whether this is accompanied with an improvement in the mechanical properties of large arteries is unknown.

Design and method: Pts with daytime ambulatory SBP/DBP (dASBP/dADBP) >135 and/or 85 mmHg, despite 4 week with irbesartan (Irb)+HCTZ+amlodipine, were randomised to SNB (n=82) or RB (n=82) for 12 weeks. Central pulse pressure (CPP) and carotid-femoral pulse wave velocity (PWV) were measured by aplanation tonometry. High-resolution echotracking system (Walltrack^®) was used to measure carotid artery diameter (Dcca), wall thickness (WT), circumferential wall stress (CWS), and stiffness. All parameters were measured at baseline and week 12.

Results: Baseline clinical characteristics did not differ between groups. dASBP decreased more in SNB (−19±12 mmHg) vs RB (−8±13 mmHg, p<10-6), either for CPP [SNB (−12.8±16.9 mmHg) vs RB (−1.0±9.3 mmHg, p<0.006)] after adjustment on baseline CPP and delta MeanBP. CCA stiffness and PWV decreased similarly in both groups. Dcca decreased more in SNB (−267±46 μm) vs RB (−7.8±39 μm, p=0.01) after adjustment on baseline D and delta ASBP. WT did not differ and CWS decreased more in SNB (−15.2±16.5 kPa) vs RB (−5.2±12.6 kPa, P=0.001).

Conclusions: In RH pts, a ttt strategy based on SNB improved CPP to a greater extent than a RB strategy. This may lead to a better target organ damage prevention and CV outcome. SNB improved CWS. Whether this effect is due aldosterone blockade or sodium depletion remains to be investigated.

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TY  - JOUR
AU  - H.B. Beaussier
AU  - M.B. Briet
AU  - F.M. Michael
AU  - G.B. Bobrie
AU  - S.P. Peyrard
AU  - P.F.P. Plouin
AU  - S.L. Laurent
AU  - M.A. Azizi
AU  - P.B. Boutouyrie
PY  - 2013
DA  - 2013/11/11
TI  - P1.10 BENEFICIAL EFFECT OF SEQUENTIAL NEPHRON BLOCKADE OF CENTRAL PRESSURE AND LARGE ARTERY REMODELLING IN RESISTANT HYPERTENSION
JO  - Artery Research
SP  - 113
EP  - 113
VL  - 7
IS  - 3-4
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2013.10.041
DO  - 10.1016/j.artres.2013.10.041
ID  - Beaussier2013
ER  -