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

DOI

10.1016/j.artres.2015.10.241How to use a DOI?

Abstract

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.

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TY  - JOUR
AU  - Andreas Jekell*
AU  - Majid Kalani
AU  - Thomas Kahan
PY  - 2015
DA  - 2015/11/23
TI  - 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
JO  - Artery Research
SP  - 14
EP  - 14
VL  - 12
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2015.10.241
DO  - 10.1016/j.artres.2015.10.241
ID  - Jekell*2015
ER  -