Antihypertensive agents and arterial stiffness: relevance to reducing cardiovascular risk in the chronic kidney disease patient.
OBJECTIVE
Arterial stiffness is a sign of diffuse adventitial macrovascular disease. The purpose of the present review is to discuss, in patients with chronic kidney disease, the pathophysiology of increased arterial stiffness, the role of antihypertensive therapy on reduction of arterial stiffness, and the clinical ways by which the prognostication of cardiovascular disease in patients with chronic kidney disease can be refined using arterial stiffness monitoring.


RESULTS
Arterial stiffness is increased with increasing prevalence of traditional cardiovascular risk factors. In patients with chronic kidney disease some unique factors further increase the risk of arterial stiffness, and include volume overload, activation of the renin-angiotensin system, anemia, and dysregulated mineral metabolism. Arterial stiffness is increased even in patients with early-stage chronic kidney disease. Blood pressure reduction when accompanied by a reduction in arterial stiffness is associated with improved prognosis. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can preferentially improve arterial stiffness, which may be an additional mechanism of cardiovascular protection with these agents.


CONCLUSIONS
The impact of improvement in arterial stiffness with antihypertensive agents on cardiovascular outcomes needs well designed clinical trials.
Agarwal
Rajiv
R
Indiana University School of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA. ragarwal@iupui.edu
D000740:Anemia / Q000473:pathology; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001158:Arteries / Q000187:drug effects / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000473:pathology*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004791:Enzyme Inhibitors / Q000494:pharmacology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000473:pathology; D007249:Inflammation / Q000473:pathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D012084:Renin-Angiotensin System; D012307:Risk Factors; D012965:Sodium Chloride / Q000494:pharmacology
D000959:Antihypertensive Agents; D004791:Enzyme Inhibitors; D012965:Sodium Chloride