Olmesartan Improves Pulse Wave Velocity and Lowers Central Systolic Blood Pressure and Ambulatory Blood Pressure in Patients With Metabolic Syndrome |
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| Authors: | Ulrike Raff MD Stefanie Walker Christian Ott MD Markus P. Schneider MD Roland E. Schmieder MD |
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| Affiliation: | Department of Nephrology and Hypertension, University of Erlangen‐Nürnberg, Erlangen‐Nürnberg, Germany |
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| Abstract: | Ambulatory blood pressure (BP) and central systolic BP (cSBP) are superior to brachial office BP measurements in predicting cardiovascular end organ damage. The authors aimed to analyze the effect of olmesartan 80 mg (OLM 80) vs 20 mg (OLM 20) vs amlodipine 5 mg (AML 5) on central hemodymamics and ambulatory BP in patients with metabolic syndrome (MetS).In a double‐blind, three‐phase crossover study comprising 69 untreated patients with MetS defined by the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults guidelines, the effects of OLM 80 on central hemodynamics (cSBP), central pulse pressure), pulse wave velocity (PWV), and 24‐hour ambulatory BP were compared with OLM 20 and AML 5, given for 6 weeks each. In 69 patients (47 men, 22 women) (51.5±9.75 years), reduction in cSBP was the highest with OLM 80 and significantly greater than the reduction with AML 5 (−14.1 mm Hg vs −9.7 mm Hg, P=.0117). All three substances significantly reduced 24‐hour ambulatory systolic (OLM 80 and OLM 20 P<.0001; AML 5 P=.0105). BP and 24‐hour diastolic BP (OLM 80 and OLM 20 P<.0001; AML 5 P=.0126). PWV was significantly reduced by OLM 80 (−0.58 m/s, P=.0088) and by OLM 20 (−0.48 m/s, P=.0362) but not by AML 5 (−0.28 m/s, P=.2065). For PWV, no significant differences were detected between the three groups. OLM significantly improves arterial stiffness as demonstrated by the reduction in PWV and in cSBP. In addition, 24‐hour ambulatory BP was reduced to a greater extent with OLM 80 than with AML 5.The metabolic syndrome (MetS) is a cluster of adverse metabolic parameters with an increasing prevalence in the Western world. Based on data from the National Cholesterol Educational Program (NCEP), an estimated 34% of men and 35% of women are affected by MetS in the United States. In Europe, about 20% to 25% of the population have MetS. Several studies clearly demonstrate that patients with MetS are at increased risk for cardiovascular mortality and morbidity.1, 2 Data from the Hoorn study shows that MetS—independent of the definition applied—is associated with a two‐fold increase of cardiovascular morbidity and mortality.1 If arterial hypertension coexists with adverse metabolic patterns of the MetS, such as abdominal obesity, hyperlipidemia, and insulin resistance, both conditions exaggerate the detrimental effects on the vasculature by altered hemodynamic and biochemical processes, consecutively resulting in severe cardiovascular end organ damage. Thus, strict control of both blood pressure (BP) and metabolic parameters is essential in preventing or reducing cardiovascular risk in patients with MetS. In the face of the evidence that different antihypertensive classes have been demonstrated to act differently on the vasculature, finding a therapeutic approach that not only reduces high BP but simultaneously exerts beneficial effects on the vasculature might be seminal in patients with MetS.Several experimental and clinical studies have reported beneficial effects of the angiotensin receptor blockers (ARBs) such as olmesartan (OLM) on vascular pathologies.3, 4, 5 Similarly, in the Conduit Artery Functional Endpoint (CAFE) study, the calcium channel blocker amlodipine (AML) was shown to be superior to the β‐blocker atenolol in reducing central systolic BP (cSBP) despite comparable impact on brachial BP.6 In this study we aimed to investigate the effect of OLM 80 mg—a dose above the approved maximum daily dose—compared with OLM 20 mg and the calcium channel blocker AML 5 mg on arterial stiffening determined by pulse wavy velocity (PWV) and on 24‐hour ambulatory BP or brachial and central BP.The OLM dose of 80 mg was chosen since BP‐independent beneficial effects have been observed above the maximum BP dose and because the observation that very high doses of ARBs, such as OLM, are not related to higher incidence of side effects, ie, there is no dose dependency of side effects with ARBs. |
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