Effect of lisinopril and atenolol on aortic stiffness in patients on hemodialysis

dc.contributor.authorGeorgianos, Panagiotis I.
dc.contributor.authorAgarwal, Rajiv
dc.contributor.departmentDepartment of Medicine, IU School of Medicineen_US
dc.date.accessioned2016-09-01T18:16:02Z
dc.date.available2016-09-01T18:16:02Z
dc.date.issued2015-04-07
dc.description.abstractBACKGROUND AND OBJECTIVES: Whether improvements in arterial compliance with BP lowering are because of BP reduction alone or if pleiotropic effects of antihypertensive agents contribute remains unclear. It was hypothesized that, among patients on hemodialysis, compared with a β-blocker (atenolol), a lisinopril-based therapy will better reduce arterial stiffness. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 200 participants of the Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril Trial, 179 patients with valid assessment of aortic pulse wave velocity at baseline (89 patients randomly assigned to open-label lisinopril and 90 patients randomly assigned to atenolol three times a week after dialysis) were included in the secondary analysis. Among them, 109 patients had a valid pulse wave velocity measurement at 6 months. Monthly measured home BP was targeted to <140/90 mmHg by addition of antihypertensive drugs and dry weight adjustment. The difference between drugs in percentage change of aortic pulse wave velocity from baseline to 6 months was analyzed. RESULTS: Contrary to the hypothesis, atenolol-based treatment induced greater reduction in aortic pulse wave velocity relative to lisinopril (between drug difference, 14.8%; 95% confidence interval, 1.5% to 28.5%; P=0.03). Reduction in 44-hour ambulatory systolic and diastolic BP was no different between groups (median [25th, 75th percentile]; atenolol: -21.5 [-37.7, -7.6] versus lisinopril: -15.8 [-28.8, -1.5] mmHg; P=0.27 for systolic BP; -14.1 [-22.6, -5.3] versus -10.9 [-18.4, -0.9] mmHg, respectively; P=0.30 for diastolic BP). Between-drug difference in change of aortic pulse wave velocity persisted after adjustments for age, sex, race, other cardiovascular risk factors, and baseline ambulatory systolic BP but disappeared after adjustment for change in ambulatory systolic BP (11.8%; 95% confidence interval, -2.3% to 25.9%; P=0.10). CONCLUSIONS: Among patients on dialysis, atenolol was superior in improving arterial stiffness. However, differences between atenolol and lisinopril in improving aortic stiffness among patients on hemodialysis may be explained by BP-lowering effects of drugs.en_US
dc.identifier.citationGeorgianos, P. I., & Agarwal, R. (2015). Effect of Lisinopril and Atenolol on Aortic Stiffness in Patients on Hemodialysis. Clinical Journal of the American Society of Nephrology : CJASN, 10(4), 639–645. http://doi.org/10.2215/CJN.09981014en_US
dc.identifier.issn1555-905Xen_US
dc.identifier.urihttps://hdl.handle.net/1805/10830
dc.language.isoen_USen_US
dc.publisherAmerican Society of Nephrology (ASN)en_US
dc.relation.isversionof10.2215/CJN.09981014en_US
dc.relation.journalClinical journal of the American Society of Nephrology: CJASNen_US
dc.rightsPublisher Policyen_US
dc.sourcePMCen_US
dc.subjectAdrenergic beta-1 Receptor Antagonistsen_US
dc.subjecttherapeutic useen_US
dc.subjectAngiotensin-Converting Enzyme Inhibitorsen_US
dc.subjectAntihypertensive Agentsen_US
dc.subjectAtenololen_US
dc.subjectKidney Diseasesen_US
dc.subjecttherapyen_US
dc.subjectLisinoprilen_US
dc.subjectRenal Dialysisen_US
dc.subjectadverse effectsen_US
dc.subjectVascular Stiffnessen_US
dc.subjectdrug effectsen_US
dc.titleEffect of lisinopril and atenolol on aortic stiffness in patients on hemodialysisen_US
dc.typeArticleen_US
ul.alternative.fulltexthttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386263/en_US
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