title: Effect of aliskiren on circulating endothelial progenitor cells and vascular function in patients with type 2 diabetes and essential hypertension.
abstract: BACKGROUND
  The aim of this study was to investigate the effects of aliskiren on vascular function and endothelial progenitor cells (EPCs) in patients with type 2 diabetes and essential hypertension.
  
  
  METHODS
  The study enrolled type 2 diabetic patients aged >50 years under stable glycemic control and first diagnosed mild essential hypertension. In phase A (n = 20), patients received aliskiren 150-300 mg daily for 3 months. In phase B (n = 12), hydrochlorothiazide (HCTZ) 12.5-25mg daily substituted for aliskiren for 3 more months. At baseline and at the end of each phase, we assessed (i) brachial blood pressure (BBP); (ii) central aortic systolic pressure (CSP), aortic augmentation index (Aix), and pulse wave velocity (PWV) as markers of arterial stiffness; (iii) brachial artery flow-mediated dilatation (FMD) as a marker of endothelial function; (iv) left ventricular (LV) twisting and untwisting as markers of LV function and (v) EPC numbers in culture of peripheral blood mononuclear cells.
  
  
  RESULTS
  Aliskiren similarly reduced BBP and CSP, increased FMD (P < 0.001) and EPC numbers (P < 0.001), decreased PWV and Aix (P < 0.05), and improved LV twisting and untwisting (P < 0.05). Although substitution of HCTZ sustained BBP at similar levels, CSP and echocardiographic indices nearly returned at baseline levels, and the improvement of FMD, PWV, Aix, and EPC numbers was abolished.
  
  
  CONCLUSIONS
  Aliskiren had a favorable effect on endothelial function and EPCs, reduced arterial stiffness, and improved LV twisting and untwisting. These effects were independent of BBP lowering, as they were not observed after the achievement of similar values of BBP with HCTZ.
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece atraptis@med.uoa.gr.
authors.forename: Athanasios E
authors.initials: AE
authors.lastname: Raptis
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Markakis
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mazioti
authors.affiliation: 2nd Department of Cardiology, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: Ignantios
authors.initials: I
authors.lastname: Ikonomidis
authors.affiliation: Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications, Athens, Greece;
authors.forename: Eirini P
authors.initials: EP
authors.lastname: Maratou
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: Dimitrios V
authors.initials: DV
authors.lastname: Vlahakos
authors.affiliation: Department of Experimental Physiology, Athens University Medical School, Athens, Greece;
authors.forename: Eleni E
authors.initials: EE
authors.lastname: Kotsifaki
authors.affiliation: 2nd Department of Cardiology, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: Asterios N
authors.initials: AN
authors.lastname: Voumvourakis
authors.affiliation: Department of Immunology-Histocompatibility, Evangelismos General Hospital, Athens, Greece.
authors.forename: Alexandra G
authors.initials: AG
authors.lastname: Tsirogianni
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: Vaia A
authors.initials: VA
authors.lastname: Lambadiari
authors.affiliation: 2nd Department of Cardiology, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: John P
authors.initials: JP
authors.lastname: Lekakis
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications, Athens, Greece;
authors.forename: Sotirios A
authors.initials: SA
authors.lastname: Raptis
authors.affiliation: 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece.
authors.forename: George D
authors.initials: GD
authors.lastname: Dimitriadis
mesh_terms: D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D002478:Cells, Cultured; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004232:Diuretics / Q000627:therapeutic use; D057915:Drug Substitution; D066026:Endothelial Progenitor Cells / Q000187:drug effects* / Q000378:metabolism; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005650:Fumarates / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D015415:Biomarkers; D004232:Diuretics; D005650:Fumarates; D006852:Hydrochlorothiazide; C446481:aliskiren
keywords: aliskiren; arterial stiffness; blood pressure; diabetes mellitus; endothelial progenitor cells; hypertension; vascular function.