beneficial effects on arterial stiffness and pulse-wave reflection of combined enalapril and candesartan in chronic kidney disease - a randomized trial有利影响动脉硬化和脉搏波反射联合卡托普利和坎地沙坦的慢性肾脏疾病u2014u2014一个随机试验.pdfVIP

Beneficial Effects on Arterial Stiffness and Pulse-Wave Reflection of Combined Enalapril and Candesartan in Chronic Kidney Disease - A Randomized Trial 1 1 2 3 2 Marie Frimodt-Møller *, Anne-Lise Kamper , Svend Strandgaard , Svend Kreiner , Arne Høj Nielsen 1 Departments of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, 2 Herlev Hospital, Copenhagen, Denmark, 3 Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark Abstract Background: Cardiovascular disease (CVD) is highly prevalent in patients with chronic kidney disease (CKD). Inhibition of the renin-angiotensinsystem (RAS) in hypertension causes differential effects on central and brachial blood pressure (BP), which has been translated into improved outcome. The objective was to examine if a more complete inhibition of RAS by combining an angiotensin converting enzyme inhibitor (ACEI) and an angiotensin receptor antagonist (ARB) compared to monotherapy has an additive effect on central BP and pulse-wave velocity (PWV), which are known markers of CVD. 2 Methods: Sixty-seven CKD patients (mean GFR 30, range 13–59 ml/min/1.73 m ) participated in an open randomized study of 16 weeks of monotherapy with either enalapril or candesartan followed by 8 weeks of dual blockade aiming at a total dose of 16 mg candesartan and 20 mg enalapril o.d. Pulse-wave measurements were performed at week 0, 8, 16 and 24 by the SphygmoCor device. Results: Significant additive BP independent reductions were found after dual blockade in aortic PWV ( 20.3 m/s, P,0.05) and in augmentation index ( 22%, P,0.01) compared to monotherapy. Furtherm