Renin-Angiotensin System Blockade Associated with Statin Improves Endothelial Function in Diabetics

• Published in: Arquivos brasileiros de cardiologia 2015-12, Vol.105 (6), p.597-605
• Main Authors: Gismondi, Ronaldo Altenburg, Bedirian, Ricardo, Pozzobon, Cesar Romaro, Ladeira, Márcia Cristina, Oigman, Wille, Neves, Mário Fritsch
• Format: Article
• Language: English
• Subjects: Amino Acids - pharmacology; Amino Acids - therapeutic use; Amlodipine - pharmacology; Amlodipine - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - pharmacology; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - pharmacology; Antihypertensive Agents - therapeutic use; Benzazepines - pharmacology; Benzazepines - therapeutic use; Blood Pressure - drug effects; Blood Pressure Monitoring, Ambulatory; Brachial Artery - drug effects; CARDIAC & CARDIOVASCULAR SYSTEMS; Diabetes Mellitus; Diabetes Mellitus, Type 2 - drug therapy; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiology; Endotélio/fisiopatologia; Female; Hipertensão; Humans; Hypertension - drug therapy; Losartan - pharmacology; Losartan - therapeutic use; Male; Middle Aged; Original; Pulse Wave Analysis; Renin-Angiotensin System - drug effects; Sistema Renina-Angiotensina/efeitos de drogas; Statistics, Nonparametric; Time Factors; Treatment Outcome; Vascular Stiffness - drug effects
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20150123

Studies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness. To analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness. Patients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively). The SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes.