Angiotensin Receptor Blockades Effect on Peripheral Muscular and Central Aortic Arterial Stiffness: A Meta-Analysis of Randomized Controlled Trials and Systematic Review.
BACKGROUND
Previous clinical trials have demonstrated the impact of blocking upstream renin-angiotensin-axis with angiotensin converting enzyme inhibitors (ACEIs) on arterial stiffness as evaluated by pulse-wave velocity (PWV). We ran a meta-analysis to evaluate the anti-stiffness effect of powerful downstream angiotensin receptor blockades (ARBs) on peripheral and central arterial stiffness (brachial to ankle, ba-PWV; carotid to femoral, cf-PWV, respectively), using a systematic review to assess the clinical arterial stiffness issues.


METHODS
For our study, we searched the PubMed and Cochrane Library databases from inception to June 2013, targeting randomized controlled trials. ARBs along with other antihypertensive agents, ACEIs, calcium channel blockers (CCBs), beta-blockers and diuretics were evaluated to ascertain their comparable effect on ba-PWV and cf-PWV, respectively. A meta-analysis was conducted utilizing the fixed or random effect of the weighted mean change difference between the ARB and comparator groups, depending on the I(2) statistic heterogeneity measurement.


RESULTS
In 2 trials treating patients with ARBs (n = 30), the ARBs insignificantly reduced levels of ba-PWV (pooled mean change difference -188, 95% CI -687, 311, p = 0.24 with significant heterogeneity) as compared to other hypertensive agents (ACEIs and CCBs, n = 77). Interestingly, ARBs (n = 20) had a superior capacity to reduce levels of ba-PWV than CCBs (n = 20) in single study results (mean change difference -400, 95% CI -477, -322, p < 0.05). In 7 trials which included a total of 653 patients, treatment with ARBs (n = 308) also insignificantly reduced cf-PWV (pool mean change difference -0.197, 95% CI -0.54, 0.14, p = 0.218) as compared to other anti-hypertensive agents.


CONCLUSIONS
Our data suggested that ARBs had a similar effect as other anti-hypertensive agents in reducing ba-PWV and cf-PWV. Upon systematic review, the renin-angiotensin-axis system mechanism seems more significant than the direct vessel dilatation system in anti-arterial stiffness mechanism.


BACKGROUND
Angiotension receptor blockage; Arterial stiffness; Meta-analysis; Systematic review.
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; ; Medicine, Nursing and Management College; ; Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei;
Chih-Hsuan
CH
Yen
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; ; Medicine, Nursing and Management College;
Yau-Huei
YH
Lai
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; ; Medicine, Nursing and Management College;
Chung-Lieh
CL
Hung
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; ; Medicine, Nursing and Management College;
Ping-Ying
PY
Lee
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital;
Jen-Yuan
JY
Kuo
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; ; Mackay Medical College, New Taipei City;
Hung-I
HI
Yeh
Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; ; Medicine, Nursing and Management College;
Charles Jia-Yin
CJ
Hou
Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei; ; Department of Internal Medicine (Cardiology), National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan.
Kuo-Liong
KL
Chien