title: Effects of a long-term treatment with aliskiren or ramipril on structural alterations of subcutaneous small-resistance arteries of diabetic hypertensive patients.
abstract: Structural alterations of subcutaneous small-resistance arteries are associated with a worse clinical prognosis in hypertension and non-insulin-dependent diabetes mellitus. The effects of the direct renin inhibitor aliskiren on microvascular structure were never previously evaluated. Therefore, we investigated the effects of aliskiren in comparison with those of an extensively used angiotensin-converting enzyme inhibitor, ramipril, on peripheral subcutaneous small-resistance artery morphology, retinal arteriolar structure, and capillary density in a population of patients with non-insulin-dependent diabetes mellitus. Sixteen patients with mild essential hypertension and with a previous diagnosis of non-insulin-dependent diabetes mellitus were included in the study. Patients were then randomized to 1 of the 2 active treatments (aliskiren 150 mg once daily, n=9; or ramipril 5 mg once daily, n=7). Each patient underwent a biopsy of the subcutaneous fat from the gluteal region, an evaluation of retinal artery morphology (scanning laser Doppler flowmetry), and capillary density (capillaroscopy), at baseline and after 1 year of treatment. Subcutaneous small arteries were dissected and mounted on a pressurized micromyograph, and the media-to-lumen ratio was evaluated. A similar office blood pressure-lowering effect and a similar reduction of the wall-to-lumen ratio of retinal arterioles were observed with the 2 drugs. Aliskiren significantly reduced media-to-lumen ratio of subcutaneous small-resistance arteries, whereas ramipril-induced reduction of media to lumen ratio was not statistically significant. No relevant effect on capillary density was observed. In conclusion, treatment with aliskiren or ramipril was associated with a correction of microvascular structural alterations in patients with non-insulin-dependent diabetes mellitus.
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Carolina
authors: C
authors: De Ciuceis
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Carmine
authors: C
authors: Savoia
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Emanuele
authors: E
authors: Arrabito
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Enzo
authors: E
authors: Porteri
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Monica
authors: M
authors: Mazza
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Claudia
authors: C
authors: Rossini
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Sarah
authors: S
authors: Duse
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Francesco
authors: F
authors: Semeraro
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Claudia
authors: C
authors: Agabiti Rosei
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Alessandro
authors: A
authors: Alonzo
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Lidia
authors: L
authors: Sada
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Elisa
authors: E
authors: La Boria
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Annamaria
authors: A
authors: Sarkar
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Beatrice
authors: B
authors: Petroboni
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Paolo
authors: P
authors: Mercantini
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Massimo
authors: M
authors: Volpe
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. damiano.rizzoni@unibs.it.
authors: Damiano
authors: D
authors: Rizzoni
authors: From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors: Enrico
authors: E
authors: Agabiti Rosei
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005650:Fumarates / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017257:Ramipril / Q000627:therapeutic use*; D012867:Skin / Q000098:blood supply; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance
chemical_list: D000577:Amides; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D005650:Fumarates; C446481:aliskiren; D017257:Ramipril
keywords: aliskiren; antihypertensive agents; capillaries; microvessels; non–insulin-dependent diabetes mellitus; ramipril