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Angiotensin II receptor blockers improve endothelial dysfunction associated with sympathetic hyperactivity in metabolic syndrome.
J Hypertens. 2012 Aug; 30(8):1646-55.JH

Abstract

OBJECTIVES

Renin-angiotensin system inhibitors are preferred for the treatment of hypertension with metabolic syndrome (MetS). Underlying endothelial dysfunction and sympathetic nervous system (SNS) activation are critically involved in the pathogenesis of hypertension in MetS. We investigated whether treatment with angiotensin II type 1 receptor blockers (ARBs) improves endothelial and autonomic function in patients with MetS.

METHODS AND RESULTS

We conducted a prospective, randomized, open-label, blinded endpoint trial. Sixty patients with MetS were randomized into three treatment groups: telmisartan, candesartan, or diet therapy (control; n = 20 each), and treated for 6 months. To evaluate the endothelial function of forearm resistance arteries, blood flow and vascular resistance were measured using a strain-gauge plethysmograph during intra-arterial infusion of acetylcholine (ACh) or sodium nitroprusside (SNP). At 6 months, both telmisartan and candesartan comparably decreased blood pressure. Furthermore, ARB treatment ameliorated impaired forearm vasodilation in response to ACh. Telmisartan had a greater effect than candesartan on ACh-induced forearm vasodilation. In contrast, forearm vasodilation in response to SNP was comparable between the telmisartan and candesartan-treated groups. ARB treatment increased high-molecular-weight (HMW) adiponectin levels and baroreflex sensitivity, but telmisartan had a stronger effect than candesartan. In addition, only telmisartan treatment significantly decreased plasma norepinephrine concentrations, blood pressure variability, and heart rate variability based on spectral analysis.

CONCLUSION

These findings indicate that ARBs improve impaired endothelial and baroreflex function, and increase HMW adiponectin levels in patients with MetS. Telmisartan exhibited more beneficial effects than candesartan, and only telmisartan reduced sympathetic hyperactivity, despite similar depressor effects.

Authors+Show Affiliations

Department of Advanced Therapeutics for Cardiovascular Diseases, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22728908

Citation

Kishi, Takuya, et al. "Angiotensin II Receptor Blockers Improve Endothelial Dysfunction Associated With Sympathetic Hyperactivity in Metabolic Syndrome." Journal of Hypertension, vol. 30, no. 8, 2012, pp. 1646-55.
Kishi T, Hirooka Y, Konno S, et al. Angiotensin II receptor blockers improve endothelial dysfunction associated with sympathetic hyperactivity in metabolic syndrome. J Hypertens. 2012;30(8):1646-55.
Kishi, T., Hirooka, Y., Konno, S., & Sunagawa, K. (2012). Angiotensin II receptor blockers improve endothelial dysfunction associated with sympathetic hyperactivity in metabolic syndrome. Journal of Hypertension, 30(8), 1646-55. https://doi.org/10.1097/HJH.0b013e328355860e
Kishi T, et al. Angiotensin II Receptor Blockers Improve Endothelial Dysfunction Associated With Sympathetic Hyperactivity in Metabolic Syndrome. J Hypertens. 2012;30(8):1646-55. PubMed PMID: 22728908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiotensin II receptor blockers improve endothelial dysfunction associated with sympathetic hyperactivity in metabolic syndrome. AU - Kishi,Takuya, AU - Hirooka,Yoshitaka, AU - Konno,Satomi, AU - Sunagawa,Kenji, PY - 2012/6/26/entrez PY - 2012/6/26/pubmed PY - 2013/1/23/medline SP - 1646 EP - 55 JF - Journal of hypertension JO - J Hypertens VL - 30 IS - 8 N2 - OBJECTIVES: Renin-angiotensin system inhibitors are preferred for the treatment of hypertension with metabolic syndrome (MetS). Underlying endothelial dysfunction and sympathetic nervous system (SNS) activation are critically involved in the pathogenesis of hypertension in MetS. We investigated whether treatment with angiotensin II type 1 receptor blockers (ARBs) improves endothelial and autonomic function in patients with MetS. METHODS AND RESULTS: We conducted a prospective, randomized, open-label, blinded endpoint trial. Sixty patients with MetS were randomized into three treatment groups: telmisartan, candesartan, or diet therapy (control; n = 20 each), and treated for 6 months. To evaluate the endothelial function of forearm resistance arteries, blood flow and vascular resistance were measured using a strain-gauge plethysmograph during intra-arterial infusion of acetylcholine (ACh) or sodium nitroprusside (SNP). At 6 months, both telmisartan and candesartan comparably decreased blood pressure. Furthermore, ARB treatment ameliorated impaired forearm vasodilation in response to ACh. Telmisartan had a greater effect than candesartan on ACh-induced forearm vasodilation. In contrast, forearm vasodilation in response to SNP was comparable between the telmisartan and candesartan-treated groups. ARB treatment increased high-molecular-weight (HMW) adiponectin levels and baroreflex sensitivity, but telmisartan had a stronger effect than candesartan. In addition, only telmisartan treatment significantly decreased plasma norepinephrine concentrations, blood pressure variability, and heart rate variability based on spectral analysis. CONCLUSION: These findings indicate that ARBs improve impaired endothelial and baroreflex function, and increase HMW adiponectin levels in patients with MetS. Telmisartan exhibited more beneficial effects than candesartan, and only telmisartan reduced sympathetic hyperactivity, despite similar depressor effects. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/22728908/Angiotensin_II_receptor_blockers_improve_endothelial_dysfunction_associated_with_sympathetic_hyperactivity_in_metabolic_syndrome_ L2 - https://doi.org/10.1097/HJH.0b013e328355860e DB - PRIME DP - Unbound Medicine ER -