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.

Open Access

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

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  -