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.

Open Access

This is an open access article distributed under the CC BY-NC license.

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  -