Combination therapy in hypertension: From effect on arterial stiffness and central haemodynamics to cardiovascular benefits☆
This article was presented as lecture in the symposium on “Arterial stiffness: a translational approach” at the ARTERY 14 Congress in Maastricht, The Netherlands (October 9–11, 2014).
- DOI
- 10.1016/j.artres.2016.02.005How to use a DOI?
- Keywords
- Aortic stiffness; Pulse wave velocity; Wave reflections; Central haemodynamics; Hypertension; Angiotensin converting enzyme inhibitors; Calcium channel blockers
- Abstract
Measures of arterial aging have the potential to improve risk prediction beyond traditional risk scores. Such biomarkers that fulfil most, or some of the strict criteria of a surrogate end-point are aortic stiffness (IIa level of recommendation in European Guidelines and Position Papers) and central haemodynamics (IIb level of recommendation). Early intervention towards improving aortic elastic properties acquires particular importance since evidence suggests that arterial stiffening may occur before the onset of hypertension. Part of the beneficial effects of antihypertensive treatment in risk reduction may be mediated through improvement in aortic stiffness and central haemodynamics. However, not all antihypertensive drugs affect aortic stiffness and central haemodynamics in a similar way. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) have beneficial effects on such parameters. Meta-analytical approaches have shown that ACE inhibitors reduce mortality in hypertension, whereas ARBs do not exhibit such a benefit. Furthermore, ACE inhibitors have been shown to reduce the risk of coronary artery disease, and CCBs to reduce the risk of stroke independently of blood pressure reduction. Combining an ACE inhibitor with a CCB has the potential to reduce cardiovascular risk (synergy at the clinical level) by reducing aortic stiffness and improving central haemodynamics (synergy at the vascular level).
- Copyright
- © 2016 Published by Elsevier B.V. on behalf of Association for Research into Arterial Structure and Physiology.
- Open Access
- This is an open access article distributed under the CC BY-NC license.
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TY - JOUR AU - Charalambos Vlachopoulos PY - 2016 DA - 2016/03/05 TI - Combination therapy in hypertension: From effect on arterial stiffness and central haemodynamics to cardiovascular benefits☆ JO - Artery Research SP - 27 EP - 35 VL - 14 IS - C SN - 1876-4401 UR - https://doi.org/10.1016/j.artres.2016.02.005 DO - 10.1016/j.artres.2016.02.005 ID - Vlachopoulos2016 ER -