Effect of add-on aliskiren to type 1 angiotensin receptor blocker therapy on endothelial function and autonomic nervous system in hypertensive patients with ischemic heart disease

Atsuko Ozeki; Eisuke Amiya; Masafumi Watanabe; Yumiko Hosoya; Munenori Takata; Aya Watanabe; Shuichi Kawarasaki; Tomoko Nakao; Shogo Watanabe; Kazuko Omori; Namie Yamada; Yukiko Tahara; Yasunobu Hirata; Ryozo Nagai

doi:10.1111/jch.12366

Effect of add-on aliskiren to type 1 angiotensin receptor blocker therapy on endothelial function and autonomic nervous system in hypertensive patients with ischemic heart disease

J Clin Hypertens (Greenwich). 2014 Aug;16(8):591-8. doi: 10.1111/jch.12366. Epub 2014 Jul 7.

Authors

Atsuko Ozeki¹, Eisuke Amiya, Masafumi Watanabe, Yumiko Hosoya, Munenori Takata, Aya Watanabe, Shuichi Kawarasaki, Tomoko Nakao, Shogo Watanabe, Kazuko Omori, Namie Yamada, Yukiko Tahara, Yasunobu Hirata, Ryozo Nagai

Affiliation

¹ Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.

Abstract

The aim of this study was to evaluate the add-on effect of aliskiren to valsartan on endothelial-dependent vasodilation in hypertensive patients with ischemic heart disease (IHD). After 4 weeks of treatment with 80 mg of valsartan, 28 patients were allocated to either continued treatment with valsartan or an add-on treatment with valsartan plus 150 mg of aliskiren. Aliskiren significantly decreased plasma renin activity, whereas endothelium-dependent vasodilation measured by flow-mediated dilation (FMD) did not change. In contrast, heart rate significantly decreased (73.1 ± 9.8 to 66.3 ± 7.0 beats per minute at baseline and 24 weeks, respectively [P = .009]) and the standard deviation of the R-R intervals (SDNN) significantly increased in the aliskiren group. The add-on aliskiren to valsartan therapy may not improve endothelial functions, although it significantly reduced resting heart rate via regulation of the autonomic nervous system in hypertensive patients with IHD.

Publication types

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

MeSH terms

Aged
Amides / pharmacology*
Amides / therapeutic use
Angiotensin II Type 1 Receptor Blockers / pharmacology*
Angiotensin II Type 1 Receptor Blockers / therapeutic use
Antihypertensive Agents / pharmacology*
Antihypertensive Agents / therapeutic use
Autonomic Nervous System / drug effects*
Autonomic Nervous System / physiology
Comorbidity
Drug Therapy, Combination
Endothelium, Vascular / drug effects*
Endothelium, Vascular / physiology
Female
Fumarates / pharmacology*
Fumarates / therapeutic use
Heart Rate / drug effects
Heart Rate / physiology
Humans
Hypertension / drug therapy
Hypertension / epidemiology
Hypertension / physiopathology*
Male
Middle Aged
Myocardial Ischemia / drug therapy
Myocardial Ischemia / epidemiology
Myocardial Ischemia / physiopathology*
Renin / antagonists & inhibitors
Renin / metabolism
Tetrazoles / pharmacology*
Tetrazoles / therapeutic use
Treatment Outcome
Valine / analogs & derivatives*
Valine / pharmacology
Valine / therapeutic use
Valsartan
Vasodilation / drug effects
Vasodilation / physiology

Substances

Amides
Angiotensin II Type 1 Receptor Blockers
Antihypertensive Agents
Fumarates
Tetrazoles
aliskiren
Valsartan
Renin
Valine