title: Long-term effects of angiotensin II receptor blockade with valsartan on carotid arterial stiffness and hemodynamic alterations in patients with essential hypertension.
abstract: Increased arterial stiffness and intima media thickness (IMT) in the common carotid artery (CCA) are related to cardiovascular risk in essential hypertension. Angiotensin II plays an important role in structural and functional changes in the vasculature. In this study, we evaluated the long-term effect of the angiotensin II receptor blocker, valsartan, on IMT, arterial stiffness, and hemodynamics in the CCA in patients with essential hypertension. A prospective 24 month study of treatment with valsartan (80-160 mg/day) was performed in 24 hypertensive patients. An ultrasound of the CCA was carried out to determine IMT, the cross-sectional distensibility coefficient (CSDC), the carotid arterial stiffness index beta, and diastolic flow velocity to systolic flow velocity ratio (Vd/Vs). Treatment with valsartan for 24 months reduced systolic and diastolic blood pressure significantly. Compared to baseline, the decrease in pulse pressure was greater after 24 months treatment than after 12 months treatment. Valsartan did not influence IMT; however, after 24 months, it caused a significant increase in CSDC and a decrease in stiffness index beta compared to baseline. These changes were not observed after 12 months of treatment. In addition, Vd/Vs, a sensitive marker of relative diastolic blood flow, increased after 24 months' treatment with valsartan. These results suggest that long-term treatment with valsartan improves vascular wall function and hemodynamics in patients with essential hypertension.
authors.affiliation: Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan. okura@m.ehime-u.ac.jp
authors.forename: Takafumi
authors.initials: T
authors.lastname: Okura
authors.forename: Sanae
authors.initials: S
authors.lastname: Watanabe
authors.forename: Mie
authors.initials: M
authors.lastname: Kurata
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Koresawa
authors.forename: Jun
authors.initials: J
authors.lastname: Irita
authors.forename: Daijiro
authors.initials: D
authors.lastname: Enomoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Jotoku
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Miyoshi
authors.forename: Tomikazu
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Higaki
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology* / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000187:drug effects; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D004548:Elasticity / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D013777:Tetrazoles / Q000494:pharmacology* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D014463:Ultrasonography; D014633:Valine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000068756:Valsartan; D014655:Vascular Resistance / Q000187:drug effects*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine