title: Efficacy of losartan for improving insulin resistance and vascular remodeling in hemodialysis patients.
abstract: Insulin resistance and vascular remodeling are prevalent and predict cardiovascular mortality in hemodialysis patients. Angiotensin II (Ang II) may be involved in both pathogenesis. In the present study, we investigated the effects of the Ang II receptor blocker losartan on insulin resistance, arterial stiffness, and carotid artery structure in hemodialysis patients. Seventy-two hemodialysis patients were randomly assigned to receive either losartan 50 mg qd (n = 36) or β-blocker bisoprolol 5 mg qd (n = 36). At the start and at month 12, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) measurements, and carotid artery ultrasound were performed, and homeostasis model assessment index of insulin resistance (HOMA-IR) was determined. During the study period, bioimpedance method was used to evaluate volume status every 3 months. Home-monitored BPs were measured at least monthly. Ambulatory BP decreased significantly and similarly by either losartan or bisoprolol. Decreases in PWVs in losartan group at the end of month 12 were significantly greater than changes in PWV in bisoprolol group (0.9 ± 0.3 vs. 0.4 ± 0.5 m/s, P = 0.021). Common carotid artery intima-media cross-sectional area decreased significantly only in patients treated with losartan (20.3 ± 4.9 vs. 19.1 ± 5.1 mm(2) , P = 0.001), and HOMA-IR was also reduced in losartan group only (1.9 ± 1.0 vs. 1.7 ± 0.8, P = 0.003). Multiple regression analysis showed significant correlations between changes in PWV and changes in HOMA-IR. With comparable BP-lowering efficacy, losartan achieved better improvement in insulin sensitivity, arterial stiffness, and carotid artery hypertrophy in hemodialysis patients. The regression of arterial stiffness may be in part through attenuation in insulin resistance.
authors.affiliation: Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Sun
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Li-Jie
authors.initials: LJ
authors.lastname: Ma
authors.affiliation: Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Nephrology, Institute of Uro-nephrology, Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors.forename: Yi-Lun
authors.initials: YL
authors.lastname: Zhou
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002339:Carotid Arteries / Q000473:pathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D066253:Vascular Remodeling / Q000502:physiology*; D059289:Vascular Stiffness / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents; D019808:Losartan
keywords: Arterial stiffness; carotid artery hypertrophy; hemodialysis; insulin resistance; losartan