Effect of losartan on ambulatory short-term blood pressure variability and cardiovascular remodeling in hypertensive patients on hemodialysis.
OBJECTIVE
Previous studies have shown increases in ambulatory short-term blood pressure (BP) variability to be related to cardiovascular disease. In this study, we examined whether an angiotensin II type 1 receptor blocker losartan would improve ambulatory short-term BP variability in hypertensive patients on hemodialysis.


METHODS
Forty hypertensive patients on hemodialysis therapy were randomly assigned to the losartan treatment group (n=20) or the control treatment group (n=20). At baseline and 6 and 12 months after the treatment, 24-h ambulatory BP monitoring was performed. Echocardiography and measurements of brachial-ankle pulse wave velocity (baPWV) and biochemical parameters were also performed before and after therapy.


RESULTS
After 6- and 12-months of treatment, nighttime short-term BP variability, assessed on the basis of the coefficient of variation of ambulatory BP, was significantly decreased in the losartan group, but remained unchanged in the control group. Compared with the control group, losartan significantly decreased left ventricular mass index (LVMI), baPWV, and the plasma levels of brain natriuretic peptide and advanced glycation end products (AGE). Furthermore, multiple regression analysis showed significant correlations between changes in LVMI and changes in nighttime short-term BP variability, as well as between changes in LVMI and changes in the plasma levels of AGE.


CONCLUSIONS
These results suggest that losartan is beneficial for the suppression of pathological cardiovascular remodeling though its inhibitory effect on ambulatory short-term BP variability during nighttime.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Hiroshi
H
Mitsuhashi
Kouichi
K
Tamura
Junji
J
Yamauchi
Motoko
M
Ozawa
Mai
M
Yanagi
Toru
T
Dejima
Hiromichi
H
Wakui
Shin-ichiro
S
Masuda
Koichi
K
Azuma
Tomohiko
T
Kanaoka
Masato
M
Ohsawa
Akinobu
A
Maeda
Yuko
Y
Tsurumi-Ikeya
Yasuko
Y
Okano
Tomoaki
T
Ishigami
Yoshiyuki
Y
Toya
Yasuo
Y
Tokita
Toshimasa
T
Ohnishi
Satoshi
S
Umemura
D052242:Adiponectin / Q000097:blood; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000842:Ankle / Q000098:blood supply; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D001916:Brachial Artery / Q000503:physiopathology; D002940:Circadian Rhythm; D005260:Female; D017127:Glycation End Products, Advanced / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy / Q000503:physiopathology; D008077:Lipoproteins, LDL / Q000097:blood; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012044:Regression Analysis; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D020257:Ventricular Remodeling / Q000187:drug effects*
C499918:ADIPOQ protein, human; D052242:Adiponectin; D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D015415:Biomarkers; D017127:Glycation End Products, Advanced; D008077:Lipoproteins, LDL; D020097:Natriuretic Peptide, Brain; D008315:Malondialdehyde; D019808:Losartan