Angiotensin receptor blockade and arterial compliance in chronic kidney disease: a pilot study.
BACKGROUND
Almost 20 million people in the US have chronic kidney disease (CKD). Cardiovascular disease and arterial wall abnormalities are common in this population. Because angiotensin II may have adverse effects on the arterial wall, we hypothesized that an angiotensin receptor blocker (ARB) would improve arterial compliance as compared with placebo in subjects with CKD.


METHODS
We performed a double-blinded, placebo-controlled pilot study in which 25 subjects with stages 2 or 3 CKD and proteinuria <1 g were randomized to either the ARB, eprosartan, or placebo and titrated to achieve a goal blood pressure (BP) <130/85 mm Hg. Arterial compliance was measured at baseline and at 8 weeks.


RESULTS
Baseline characteristics were similar between the groups and included mean estimated glomerular filtration rate 63 +/- 14 ml/min/1.73 m(2), heart rate 76 +/- 10 beats/min, BP 142 +/- 12/81 +/- 8 mm Hg, 64% diabetic, 44% male, and 40% white, though subjects in the eprosartan group were younger (60 +/- 12 vs. 70 +/- 6 years, p = 0.01). There were no significant differences between the groups in large or small artery compliance measurements either at baseline or at 8 weeks, but there was a statistically significant improvement from baseline in small artery compliance in the eprosartan group (from median 2.5 ml/mm Hg x 100 [90% CI (1.1, 4.7)] to 4.0 ml/mm Hg x 100 [90% CI (1.9, 6.7)] (p = 0.01)) not seen in the placebo group.


CONCLUSIONS
Use of an ARB to achieve recommended BP is associated with improved small artery compliance in people with CKD, though larger studies are needed to confirm these findings.
Garg
Jay P
JP
Division of Nephrology, Department of Medicine, University of California-San Francisco, USA. jaygarg@hotmail.com
Ellis
Renee
R
Elliott
William J
WJ
Hasabou
Nahla
N
Chua
Dave
D
Chertow
Glenn M
GM
Bakris
George L
GL
D000179:Acrylates / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology* / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists; D001158:Arteries / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000150:complications; D002908:Chronic Disease; D003187:Compliance; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007093:Imidazoles / Q000494:pharmacology* / Q000627:therapeutic use; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011945:Receptors, Angiotensin / Q000187:drug effects; D013876:Thiophenes / Q000494:pharmacology* / Q000627:therapeutic use
D000179:Acrylates; D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D007093:Imidazoles; D011945:Receptors, Angiotensin; D013876:Thiophenes; C068373:eprosartan