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Short-term effects of angiotensin receptor blockers on blood pressure control, and plasma inflammatory and fibrinolytic parameters in patients taking angiotensin-converting enzyme inhibitors

Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey, agirbasli{at}gmail.com

Altug Cincin

Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey

Oytun A Baykan

Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey

Introduction. Angiotensin-converting enzyme (ACE) inhibitors reduce cardiovascular events in patients with established vascular disease and heart failure (HF). ACE-inhibitors have important effects on fibrinolytic balance, which may be the underlying mechanism for a reduction in cardiovascular events.Although angiotensin-receptor blockers (ARBs) offer greater tolerability than ACE-inhibitors, the major ARB trials have demonstrated a lack of reduction in myocardial infarction (MI) occurrence and mortality in contrast to ACE-inhibitors. In this study, we investigated the combined effects of ARBs and ACE-inhibitors on fibrinolytic and inflammatory parameters in patients with uncontrolled hypertension.

Methods. Twenty-four patients with uncontrolled hypertension despite taking adequate doses of ACE-inhibitor therapy were selected. Patients were started on Candesartan 16 mg once a day. Plasma plasminogen activator inhibitor (PAI-1) antigen (Ag), tissue plasminogen activator (t-PA) Ag, thrombin-activatable fibrinolysis inhibitor (TAFI) % activity and high sensitivity C-reactive protein (hsCRP) levels, were measured during low salt intake at baseline and two weeks after therapy with an ARB.

Results. Addition of ARB to the regimen reduced systolic (155±17 R vs. 139±13, p<0.001), and diastolic (91±9 vs. 81±8, p<0.001) blood pressures (BP). No significant changes were observed in PAI-1 Ag (66±51 vs. 68±52, p=0.9), t-PAAg (12.6±5.3 vs. 13.3±4.7, p=0.3),TAFI % activity (119±30 vs. 118±32, p=0.9) and hsCRP (3.9±3.4 vs. 3.6±3.6, p=0.7) levels after adding an ARB.

Conclusions. Combined ARB and ACE-inhibitor use provide better BP control without any detrimental effect in plasma inflammatory and fibrinolytic parameters.

Key Words: angiotensin-converting enzyme inhibitor • angiotensin receptor blocker • high sensitive C-reactive protein • hypertension • plasma plasminogen activator inhibitor • tissue plasminogen activator

Journal of Renin-Angiotensin-Aldosterone System, Vol. 9, No. 1, 22-26 (2008)
DOI: 10.3317/jraas.2008.004


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