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Journal of Renin-Angiotensin-Aldosterone System
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Review: Arterial stiffness and the renin-angiotensin-aldosterone system

Azra Mahmud

Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences and Hypertension Clinic, St. James's Hospital, Dublin 8, Ireland, mahmuda{at}tcd.ie

John Feely

Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences and Hypertension Clinic, St. James's Hospital, Dublin 8, Ireland

Arterial stiffness has recently been recognised as an independent risk factor for cardiovascular morbidity and mortality in hypertension. Many of the complications seen with angiotensin II (Ang II) excess or hyperaldosteronism — an increased event rate, left ventricular hypertrophy, endothelial dysfunction and target organ damage — are also associated with arterial stiffness. It is possible that reduced arterial compliance may be one mechanism whereby increased activity of the renin-angiotensin-aldosterone system (RAAS) produces adverse vascular effects. Common pathophysiological processes, altered collagen turnover and increased fibrosis may underlie both arterial stiffness and RAAS-associated vascular damage. While it is recognised that patients with hyperaldosteronism have increased arterial stiffness, the role of the RAAS in modulating arterial compliance in essential hypertension and in normotensive subjects is less clear cut. There is, however, more consistent data which show that drugs that interfere with Ang II or aldosterone, namely angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and aldosterone antagonists, all reduce arterial stiffness. In many cases, this is to a greater extent than predicted from the extent of reduction in blood pressure (BP), suggesting a role for RAAS in vascular stiffness in hypertensive subjects. There is also evidence that combined ACE inhibitors (ACE-Is) and ARBs may have an additive effect in reducing stiffness. The reduction in cardiovascular mortality in end-stage renal disease patients treated with ACE-Is was preferentially seen in those who had reduced arterial stiffness. These data suggest that, in addition to regulation of vascular biology and BP, the RAAS is an important determinant of arterial stiffness in health and, more particularly, in disease.

Key Words: blood pressure • renin-angiotensin-aldosterone system • wave reflection • arterial stiffness

References

  • Asmar R. Arterial stiffness and pulse wave velocity. Amsterdam: Elsevier, 2000;9-15.
  • Blacher J., Asmar R., Djane S., London GM, Safar ME Aortic
  • pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999;33:1111-17.[Abstract/Free Full Text]
  • Laurent S., Boutouyrie P., Asmar R. et al.Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236-41.[Abstract/Free Full Text]
  • Blacher J., Guerin AP, Pannier B., Marchais SJ, Safar M., London GM Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434-9.[Abstract/Free Full Text]
  • Laurent S., Katsahian S., Fassot C. et al.Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003;34:1-4.[Free Full Text]
  • Guerin AP, Blacher J., Pannier B., Marchais SJ, Safar ME, London GM Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation 2001;103: 987-92.[Abstract/Free Full Text]
  • Safar ME, Blacher J., Pannier B. et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002; 39:735-8.[Abstract/Free Full Text]
  • Nichols WW, Edwards DG Arterial elastane and wave reflection augmentation of systolic blood pressure: deleterious effects and implications for therapy. J Cardiovasc Pharmacol Ther 2001;6:5-21.[Abstract/Free Full Text]
  • Weber T., Auer J., O'Rourke MF et al.Arterial stiffness, wave reflections and coronary heart disease. Circulation 2004; 109:184-9.[Abstract/Free Full Text]
  • London GM, Blacher J., Pannier B., Guerin AP, Marchais SJ, Safar ME Arterial wave reflections and survival in end-stage renal failure. Hypertension 2001;38:434-8.[Abstract/Free Full Text]
  • Tobian L. Salt and hypertension lessons from animal models that relate to human hypertension. Hypertension 1991;7:A152-A158.
  • Schlaich MP, Klingbeil A., Kilger K., Schobel HP, Schmieder RE Relation between the renin-angiotensin-aldosterone system and left ventricular structure and function in young normotensive and mildly hypertensive subjects. Am Heart J 1999;138: 810-17.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Avolio A., Clyde CM, Beard TC, Cooke HM, Ho KK, O'Rourke MF Improved arterial distensibility in normotensive subjects on a low salt diet. Arteriosclerosis 1986;6:166-9.[Abstract/Free Full Text]
  • Gates PE, Tanaka H., Hiatt WR, Seals DR Dietary sodium restriction rapidly improves large elastic artery compliance in older adults with systolic hypertension. Hypertension 2004;44:35-41.[Abstract/Free Full Text]
  • Benetos A., Xiao YY, Cuche JL, Hannaert P., Safar M. Arterial effects of salt restriction in hypertensive patients: a 9 week randomised double-blind, crossover study. J Hypertens 1992;10: 355-60.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Rehman A., Rahman AR, Rasool AH, Naing NN The effects of angiotensin II on pulse wave velocity in healthy humans. Int J Clin Pharmacol Ther 2001;39:423-30.[Web of Science][Medline] [Order article via Infotrieve]
  • Wilkinson I., MacCallum H., Hupperetz PC, van Thoor CJ, Cockcroft JR, Webb DJ Changes in the derived central pressure waveform and pulse pressure in response to angiotensin II and noradrenaline in man. J Physiol 2001;530:541-50.[Abstract/Free Full Text]
  • Vingerhoedt NM, Gilles R., Howes JB, Griffin M., Howes LG Haemodynamic and pulse wave responses to intravenous infusions of angiotensin II during chronic telmisartan therapy in normal volunteers. JRAAS 2003;4:244-8.[Medline] [Order article via Infotrieve]
  • Clarkson PB, Wheeldon NM, MacLeod C., Tennent M., MacDonald T. Effects of angiotensin II and aldosterone on diastolic function in vivo in normal man. Clin Sci 1994;87:397401.
  • Benetos A., Gauthier S., Ricard S. Influence of angiotensin converting enzyme and angiotensin II type 1 receptor gene polymorphisms on aortic stiffness in normotensive and hypertensive patients. Circulation 1996;94:698-703.[Abstract/Free Full Text]
  • Nurnberger J., Saez AO, Mitchell A. et al. The T-allele of the C825T polymorphism is associated with higher arterial stiffness in young healthy males. J Hum Hypertens 2004;18:267-71.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Bozec E., Lacolley P., Bergaya S. et al. Arterial stiffness and angiotensinogen gene in hypertensive patients and mutant mice. J Hypertens 2004;22:1299-307.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Mattace-Raso FU, van der Cammen TJ, Sayed-Tabatabaei FA et al. Angiotensin-converting enzyme gene polymorphism and common carotid stiffness. The Rotterdam study. Atherosclerosis 2004;174:121-6.[CrossRef][Medline] [Order article via Infotrieve]
  • Hanon O., Loung V., Mourad JJ, Bortolotto LA, Jeunemaitre X., Girerd X. Ageing, carotid artery distensibility and the SER422GLY elastin gene polymorphism in humans. Hypertension 2001;38:1185-9.[Abstract/Free Full Text]
  • Brull DJ, Murray LY, Boreham CA et al. Effect of a COLIA1 Sp1 binding site polymorphism on arterial pulse wave velocity. An index of compliance. Hypertension 2001;38:444-8.[Abstract/Free Full Text]
  • BenetosA, Okuda K., Lajemi M. et al.Telomere length as an indicator of biological aging: the gender effect and relation with pulse pressure and pulse wave velocity. Hypertension 2001;37:381-5.[Abstract/Free Full Text]
  • Safar ME, Blacher MD, Mourad JJ, London GM Stiffness of carotid artery wall material and blood pressure in humans; application to antihypertensive therapy and stroke prevention. Stroke 2000;31:782-90.[Abstract/Free Full Text]
  • Medley TL, Cole TJ, Dart AM, Gatzka CD, Kingwell BA Matrix metalloproteinase-9 genotype influences large artery stiffness through effects on aortic gene and protein expression. Arterioscler Thromb Vasc Biol 2004;24:1479-84.[Abstract/Free Full Text]
  • Arima S., Kohagura K., Xu HL et al. Endothelium-derived nitric oxide modulates vascular action of aldosterone in renal arteriole.Hypertension 2004;43:352-7.[Abstract/Free Full Text]
  • Farquharson CA, Struthers AD Aldosterone induces acute endothelial dysfunction in vivo in humans: evidence for an aldosterone-induced vasculopathy. Clin Sci 2002;103:425-31.[Web of Science][Medline] [Order article via Infotrieve]
  • Schmidt BM, Oehmer S., Delles C. et al. Rapid non-genomic effects of aldosterone on human forearm vasculature. Hypertension 2003;42:156-60.[Abstract/Free Full Text]
  • Duprez D., De Buyzere M., Rietzschel ER Aldosterone and vascular damage. Current Hypertension Rep 2000;2:327-34.[CrossRef]
  • Schmidt BMW, Schmieder REAldosterone-induced cardiac damage: focus on blood pressure independent effects. Am J Hypertens 2003;16:80-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Lacolley P., Labat C., Pujol A., Delcayre C., Benefit A., Safar M. Increased carotid wall elastic modulus and fibronectin in aldosterone-salt-treated rats: effects of eplerenone. Circulation 2002;106:2848-53.[Abstract/Free Full Text]
  • Zannad F., Alla F., Dousset B., Perez A., Pitt B. Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure. Circulation 2000;102:2700.[Abstract/Free Full Text]
  • Blacher J., Amah G., Girerd X. et al. Association between increased plasma levels of aldosterone and decreased systemic arterial compliance in subjects with essential hypertension. Am J Hypertens 1997;10:1326-34.[Web of Science][Medline] [Order article via Infotrieve]
  • Resnick LM, Catanzaro D., Sealey JE, Laragh JH Acute vascular effects of the angiotensin II receptor antagonist olmesartan in normal subjects: relation to the renin-aldosterone system. Am J Hypertens 2004;17:203-08.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • MahmudA., FeelyJ. Aldosterone antagonism reduces arterial stiffness; relationship to aldosterone renin ratio. J Hum Hypertens 2003;17:S19-S20.
  • Pojoga L., Gautier S., Blanc H. et al. Genetic determination of plasma aldosterone levels in essential hypertension. Am J Hypertens 1998;11:856-60.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Veglio F., Molino P., Cat Genova G. et al. Impaired baroreflex function and arterial compliance in primary aldosteronism. J Hum Hypertens 1999;13:29-36.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Lim PO, Donnan PT, MacDonaldTM Aldosterone to renin ratio as a determinant of exercise blood pressure response in hypertensive patients. J Hum Hypertens 2001;15:119-23.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Mahmud A., Feely J. Antihypertensive drugs and arterial stiffness. Exp Rev Cardiovasc Ther 2003;1:89-102.
  • Ting C.-T, Chen C.-H, Chang M.-S,Yin FCP. Short- and long-term effects of antihypertensive drugs on arterial reflections, compliance and impedance. Hypertension 1995;26:524-30.[Abstract/Free Full Text]
  • Topouchian J., Brisac A.-M, Pannier B., Vicaut E., Safar M. Assessment of the acute arterial effects of converting enzyme inhibition in essential hypertension: a double-blind comparative and crossover study. J Hum Hypertens 1998;12:181-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Benetos A., Vasmant D.,Thiery P., Safar M. Effects of ramipril on arterial hemodynamics. J Cardiovasc Pharmacol 1991; 18:S153-S156.[Web of Science][Medline] [Order article via Infotrieve]
  • De Cesaris R., Ranieri G., Filitti V., Andriani A., Bonfantino MV Forearm arterial distensibility in patients with hypertension: comparative effects of long-term ACE inhibition and β-blocking. Clin Pharmacol Ther 1993;53:360-7.[Web of Science][Medline] [Order article via Infotrieve]
  • De Luca N., Rosiello G., Lamenza F. Reversal of cardiac and large artery structural abnormalities induced by long-term antihypertensive treatment with trandolopril. Am J Cardiol 1992; 70:52D-59D.[CrossRef][Medline] [Order article via Infotrieve]
  • Schartl M., Boksch WG, Dreysse S. Remodelling of myocardium and arteries by chronic angiotensin converting enzyme inhibition in hypertensive patients. J Hypertens 1994;12:S37-S42.
  • Albaladejo P., Bouaziz H., Duriez M. Angiotensin converting enzyme inhibition prevents the increase in aortic collagen in rats. Hypertension 1994;23:74-82.[Abstract/Free Full Text]
  • London GM, Pannier B., Vicaut E. et al. Antihypertensive effects and arterial haemodynamic alterations during angiotensin converting enzyme inhibition. J Hypertens 1996;14:1139-46.[Web of Science][Medline] [Order article via Infotrieve]
  • Levy BI, Michel J-B., Salzmann J-L., Devissageut M., Safar ME Remodelling of heart and arteries by chronic converting enzyme inhibition in spontaneously hypertensive rats. Am J Hypertens 1991;4:240S-24C5S.[Medline] [Order article via Infotrieve]
  • Benetos A., Cambien FA, Gautier S. Influence of the agiotensin II type 1 receptor gene polymorphism on the effects of perindopril and nitrendipine on arterial stiffness in hypertensive individuals.Hypertension 1996;28:1081-4.[Abstract/Free Full Text]
  • Mahmud A., Feely J. Favourable effects on arterial wave reflection and pulse pressure amplification of adding angiotensin II receptor blockade in resistant hypertension. J Hum Hypertens 2000;14:541-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • MahmudA, Feely J. Effect of angiotensin II receptor blockade on arterial stiffness: beyond blood pressure reduction. Am J Hypertens 2002;15:1092-5.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Klingbeil AU, John S., Schneider MP, Jacobi J., Weidinger G., Schmieder REAT-1 receptor blockade improves augmentation index: a double-blind, randomised, controlled study. J Hypertens 2002;20:2423-8.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Klemsdal TO, Moan A., Kjeldsen SE Effects of selective angiotensin II type 1 receptor blockade with losartan on arterial compliance in patients with mild essential hypertension. Blood Pressure 1999;8:214-19.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Schriffrin EL, Park JB, Intengan HD Correction of arterial structure and endothelial function in human essential hypertension by the angiotensin receptor antagonist losartan. Circulation 2000;101:1653-9.[Abstract/Free Full Text]
  • Asmar R. Effect of telmisartan on arterial distensibility and central blood pressure in patients with mild to moderate hypertension and Type 2 diabetes mellitus. JRAAS 2001;2(suppl 2):S8-S11.
  • Mahmud A., Feely J. Reduction in arterial stiffness with angiotensin II antagonist is comparable with and additive to ACE inhibition. Am J Hypertens 2002;15:321-5.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Ghiadoni L., Virdis A., Magagna A., Taddei S., Salvetti A. Effect of the angiotensin II receptor blocker candesartan on endothelial function in patients with essential hypertension. Hypertension 2000;35:501-06.[Abstract/Free Full Text]
  • Hornig B., Landmesser U., Kohler C. et al. Comparative effect of ACE inhibition and angiotensin II type 1 receptor antagonism on bioavailability of nitric oxide in patients with coronary artery disease. Role of superoxide dismutase. Circulation 2001;103:799-805.[Abstract/Free Full Text]
  • Richer C., Bruneval P., Ménard J., Giudicelli JF Additive effects of enalapril and losartan in (mREN-2) 27 Transgenic rats. Hypertension 1998;31:692-8.[Abstract/Free Full Text]
  • Jorde UP, Ennezat PV, Lisker J. et al. Maximally recommended doses of angiotensin-converting enzyme (ACE) inhibitors do not completely prevent ACE-medicated formation 2000;101:844-6. of angiotensin II in chronic heart D failure. Circulation 2000;101:844-6[Abstract/Free Full Text]
  • Lombes M., Oblin ME, Gasc JM, Baulieu EE, Farman N., Bonvalet JP Immunohistochemical and biochemical evidence of a cardiovascular mineralocorticoid receptor. Circ Res 1992; 71:503-10.[Abstract/Free Full Text]
  • Safar ME The arterial system in human hypertension. In: Swales JD (ed.). Textbook of Hypertension. London: Blackwell Scientific, 1994;85-102.
  • Laurent S., Lacolley P., Cuche JL, Safar ME Influence of diuretics on brachial artery diameter and distensibility in hypertensive patients. Fund Clin Pharmacol 1990;4:685-93.[Web of Science][Medline] [Order article via Infotrieve]
  • Mahmud A., Feely J. Spironolactone reduces arterial stiffness - evidence of a blood pressure independent effect. Circulation 2002;106:II-384.
  • White WB, Duprez D., St Hillaire R. et al. Effects of selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension. Hypertension 2003;41:1021-6.[Abstract/Free Full Text]
  • Chen CH,Ting C-T., Lin SJ, Hsu TL, Yin ICP, Siu CO Different effects of fosinopril and atenolol on wave reflection in hypertension patients. Hypertension 1995;25:1034-41.[Abstract/Free Full Text]
  • Pannier BM, Guerin AP, Marchais SJ, London GM Different aortic reflection wave responses following long-term angiotensin-converting enzyme inhibition and beta-blocker in essential hypertension. Clin Exper Pharmacol 2001;28:1074-7.[CrossRef]
  • Lacourciere Y., Beliveau R., Conter HS et al., Canadian Hypertension Society. Effects of perindopril on elastic and structural properties of large arteries in essential hypertension. Can J Cardiol 2004;20:795-9.[Web of Science][Medline] [Order article via Infotrieve]
  • Asmar RG, Lannascoli F., Benetos A., Safar ME Dose optimization study of arterial changes associated with angiotensin converting enzyme inhibition in hypertension. J Hypertens 1992;10:S13-S19.[CrossRef]
  • Asmar RG, Benetos A., Darne BM, Pauly NC, Safar ME Converting enzyme inhibition: dissociation between antihypertensive and arterial effects. J Hum Hypertens 1992;6:381-5.[Web of Science][Medline] [Order article via Infotrieve]
  • Spratt JC, Webb DJ, Shiels A., Williams B. Effects of candesartan on cardiac and arterial structure and function in hypertensive subjects.JRAAS 2001;2:227-32.[Medline] [Order article via Infotrieve]
  • Asmar R., Gosse P., Topouchian J., N'tela G., Dudley A., Shepherd GL Effects of telmisartan on arterial stiffness in type 2 diabetes patients with essential hypertension. JRAAS 2002;3:176-80.[Medline] [Order article via Infotrieve]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 5, No. 3, 102-108 (2004)
DOI: 10.3317/jraas.2004.025
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