Effects of angiotensin II type 1 receptor blocker on blood pressure variability and cardiovascular remodeling in hypertensive patients on chronic peritoneal dialysis.
OBJECTIVE
In this study, we examined whether addition of an angiotensin II type 1 receptor blocker (ARB), candesartan or valsartan, to conventional antihypertensive treatment could improve blood pressure (BP) variability in hypertensive patients on peritoneal dialysis.


METHODS
45 hypertensive patients on chronic peritoneal dialysis therapy were randomly assigned to the ARB treatment groups either by candesartan (n = 15) or valsartan (n = 15), or the control group (n = 15). At baseline and 6 months after the treatment, 24-hour ambulatory BP monitoring, echocardiography, and measurement of brachial-ankle pulse wave velocity (baPWV) were performed.


RESULTS
After the 6 months of treatment, 24-hour ambulatory BP values were similarly decreased in both the control group and ARB groups. However, short-term BP variability assessed on the basis of the standard deviation of 24-hour ambulatory BP was significantly decreased in the ARB groups, but remained unchanged in the control group. Furthermore, parameters of cardiovascular remodeling assessed by natriuretic peptides, echocardiography, and baPWV were significantly improved in the ARB groups but not in the control group.


CONCLUSIONS
ARB treatment and control antihypertensive treatment similarly controlled 24-hour ambulatory BP values in hypertensive patients on peritoneal dialysis. However, ARB treatment is beneficial for the suppression of pathological cardiovascular remodeling with a decrease in BP variability.
Shigenaga
Atsu-ichiro
A
Department of Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
Tamura
Kouichi
K
Dejima
Toru
T
Ozawa
Motoko
M
Wakui
Hiromichi
H
Masuda
Shin-ichiro
S
Azuma
Koichi
K
Tsurumi-Ikeya
Yuko
Y
Mitsuhashi
Hiroshi
H
Okano
Yasuko
Y
Kokuho
Toshiharu
T
Sugano
Teruyasu
T
Ishigami
Tomoaki
T
Toya
Yoshiyuki
Y
Uchino
Kazuaki
K
Tokita
Yasuo
Y
Umemura
Satoshi
S