title: Improvement of Plasma Biomarkers after Switching Stroke Patients from Other Angiotensin II Type I Receptor Blockers to Olmesartan.
abstract: BACKGROUND
  Managing hypertension is crucial for preventing stroke recurrence. Some stroke patients experience resistant hypertension. In our experimental stroke model, olmesartan increased the expression of angiotensin (Ang) II converting enzyme-2. We hypothesized that switching to olmesartan affects biomarkers and the blood pressure (BP) in stroke patients whose BP is insufficiently controlled by standard doses of Ang II type I receptor blockers (ARBs) other than olmesartan.
  
  
  METHODS
  We recruited 25 patients to study our hypothesis. All had a history of stroke or silent cerebral infarction. We switched them to olmesartan (10-40 mg per day) for 12 weeks and determined their plasma level of Ang-(1-7), peroxiredoxin, oxidized low-density lipoprotein (oxLDL)/β-2-glycoprotein I (β2GPI) complex, adiponectin, high mobility group box 1 (HMGB1), and tumor necrosis factor-α (TNFα) and recorded their BP before and after olmesartan treatment.
  
  
  RESULTS
  After switching the patients to olmesartan, their plasma level of Ang-(1-7) as a vasoprotective indicator and adiponectin regulating metabolic syndrome was increased, and peroxiredoxin and the oxLDL/β2GPI complex indicating its antioxidative stress and its proatherogenicity were lower than their baseline. This suggests that olmesartan may be more effective than other ARBs to improve these conditions. Neither HMGB1 nor TNFα reflecting an inflammatory response was affected, suggesting that the anti-inflammatory effects of olmesartan are similar to those of other ARBs. The recommended BP (<140/90) was obtained in 10 of the 25 patients after switching to olmesartan. No adverse events occurred.
  
  
  CONCLUSIONS
  Switching from other ARBs to olmesartan may be a promising therapeutic option in patients with resistant hypertension.
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan. Electronic address: yoshiteru.tada@hotmail.co.jp.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yagi
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uno
authors.affiliation: Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Matsushita
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Kanematsu
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kuwayama
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Nishi
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirasawa
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Keiko T
authors.initials: KT
authors.lastname: Kitazato
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Kageji
authors.affiliation: Department of Cell Chemistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Matsuura
authors.affiliation: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
mesh_terms: D000368:Aged; D000803:Angiotensin I / Q000097:blood; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood*; D001794:Blood Pressure / Q000187:drug effects; D057915:Drug Substitution; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007564:Japan; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D000068557:Olmesartan Medoxomil / Q000009:adverse effects / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000097:blood; D054464:Peroxiredoxins / Q000097:blood; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D053482:beta 2-Glycoprotein I / Q000097:blood
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D015415:Biomarkers; D008077:Lipoproteins, LDL; D010446:Peptide Fragments; D053482:beta 2-Glycoprotein I; C099252:oxidized low density lipoprotein; D000068557:Olmesartan Medoxomil; D000803:Angiotensin I; D054464:Peroxiredoxins; C118790:angiotensin I (1-7)
keywords: Adiponectin; LDL/β-2-glycoprotein I complex; angiotensin-(1-7); hypertension; olmesartan; peroxiredoxin