Beneficial Effects on Arterial Stiffness and Pulse-Wave Reflection of Combined Enalapril and Candesartan in Chronic Kidney Disease - A Randomized Trial 英文参考文献.docVIP

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Beneficial Effects on Arterial Stiffness and Pulse-Wave Reflection of Combined Enalapril and Candesartan in Chronic Kidney Disease - A Randomized Trial 英文参考文献.doc

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Beneficial Effects on Arterial Stiffness and Pulse-Wave Reflection of Combined Enalapril and Candesartan in Chronic Kidney Disease - A Randomized Trial 英文参考文献

BeneficialEffectsonArterialStiffnessandPulse-Wave ReflectionofCombinedEnalaprilandCandesartanin ChronicKidneyDisease-ARandomizedTrial MarieFrimodt-M?ller1*,Anne-LiseKamper1,SvendStrandgaard2,SvendKreiner3,ArneH?jNielsen2 1DepartmentsofNephrology,Rigshospitalet,UniversityofCopenhagen,Copenhagen,Denmark,2HerlevHospital,Copenhagen,Denmark,3DepartmentofBiostatistics, UniversityofCopenhagen,Copenhagen,Denmark Abstract Background:Cardiovasculardisease(CVD)ishighlyprevalentinpatientswithchronickidneydisease(CKD).Inhibitionofthe renin-angiotensinsystem(RAS)inhypertensioncausesdifferentialeffectsoncentralandbrachialbloodpressure(BP),which has been translated into improved outcome. The objective was to examine if a more complete inhibition of RAS by combininganangiotensinconvertingenzymeinhibitor(ACEI)andanangiotensinreceptorantagonist(ARB)comparedto monotherapyhasanadditiveeffectoncentralBPandpulse-wavevelocity(PWV),whichareknownmarkersofCVD. Methods:Sixty-sevenCKDpatients(meanGFR30,range13–59ml/min/1.73m2)participatedinanopenrandomizedstudy of16weeksofmonotherapywitheitherenalaprilorcandesartanfollowedby8weeksofdualblockadeaimingatatotal doseof16mgcandesartanand20mgenalaprilo.d.Pulse-wavemeasurementswereperformedatweek0,8,16and24by theSphygmoCordevice. Results:SignificantadditiveBPindependentreductionswerefoundafterdualblockadeinaorticPWV(20.3m/s,P,0.05) and in augmentation index (22%, P,0.01) compared to monotherapy. Furthermore pulse pressure amplification was improved(P,0.05)andcentralsystolicBPreduced(26mmHg,P,0.01). Conclusions: Dual blockade of the RAS resulted in an additive BP independent reduction in pulse-wave reflection and arterialstiffnesscomparedtomonotherapyinCKDpatients. TrialRegistration:CNCCitation: Frimodt-M?ller M, Kamper A-L, Strandgaard S, Kreiner S, Nielsen AH (2012) Beneficial Effects on Arterial Stiffness and Pulse-Wave Reflection of CombinedEnalaprilandCandesartaninChronicKidneyDisease-ARandomizedTrial.PLoSONE7(7):e41757.doi:10.1371/jou