Low doses of losartan and trandolapril improve arterial stiffness in hemodialysis patients.
BACKGROUND
Hemodialysis patients have uremic dyslipidemia, represented by elevated serum intermediate-density lipoprotein cholesterol (IDL-C) levels, and an increased cardiovascular mortality rate. This study was performed to determine the low-dose effects of the angiotensin II receptor blocker losartan and the angiotensin-converting enzyme inhibitor trandolapril on pulse wave velocity (PWV), which predicts cardiovascular morbidity and mortality in hemodialysis patients.


METHODS
Serum lipid levels and PWV were monitored for 12 months in 64 hemodialysis patients who were administered low doses of losartan or trandolapril or a placebo.


RESULTS
At the start of the study, there were no differences in patient characteristics among the 3 groups. PWV tended to increase in the placebo group during the 12-month study period, but decreased significantly in the losartan and trandolapril groups, and decreases in PWV were similar in the losartan and trandolapril groups. There were no changes in blood pressure, hematocrit, erythropoietin dose, ankle-brachial index, serum lipid levels, serum 8-isoprostane levels, or serum C-reactive protein levels during the 12-month study period, but there was an increase in serum triglyceride levels in the losartan group and a decrease in serum IDL-C levels in the losartan and trandolapril groups.


CONCLUSIONS
In hemodialysis patients, trandolapril is as effective as losartan in decreasing PWV independent of its depressor effect and in suppressing elevated IDL-C levels. Long-term blockade of the renin-angiotensin system may have a beneficial effect on the acceleration of atherosclerosis and uremic dyslipidemia.
Ichihara
Atsuhiro
A
Internal Medicine, Keio University School of Medicine, Tokyo, Japan. atzichi@sc.itc.keio.ac.jp
Hayashi
Matsuhiko
M
Kaneshiro
Yuki
Y
Takemitsu
Tomoko
T
Homma
Koichiro
K
Kanno
Yoshihiko
Y
Yoshizawa
Mamoru
M
Furukawa
Tomohiro
T
Takenaka
Tsuneo
T
Saruta
Takao
T
D000368:Aged; D000740:Anemia / Q000150:complications / Q000188:drug therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D015897:Comorbidity; D015237:Dinoprost / Q000031:analogs & derivatives / Q000097:blood; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000209:etiology; D007211:Indoles / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008055:Lipids / Q000097:blood; D008074:Lipoproteins / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D019808:Losartan / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D007211:Indoles; D008055:Lipids; D008074:Lipoproteins; D008077:Lipoproteins, LDL; C030104:lipoprotein cholesterol; C099252:oxidized low density lipoprotein; D004921:Erythropoietin; C052035:trandolapril; C075750:8-epi-prostaglandin F2alpha; D002097:C-Reactive Protein; D002784:Cholesterol; D015237:Dinoprost; D019808:Losartan