To evaluate the effect of valsartan treatment on cerebrovascular reactivity (CVR) and arterial stiffness in hypertensive patients with rheumatoid arthritis (RA).Design and Method:
Investigation of CVR and arterial stiffness, 24-h ambulatory blood pressure (BP) monitoring were performed in 34 hypertensive patients with RA (male/female 1/33, age 61 [54; 64] years, systolic/diastolic BP 142 [131; 149]/79 [77; 90] mmHg) before (W0) and after 24 weeks valsartan treatment (W24). Valsartan administered 40–320 mg per day. CVR was evaluated by bilateral transcranial Doppler sonography of the middle cerebral arteries (MCA) in hypercapnia (HC). We measured MCA time average maximal blood flow velocity (TAMX), peak systolic velocity (Vps) at baseline, during 2 min inhalation of the 4% mixture of carbonic gas with air (CO2) and during 3 min recovery phase. Arterial stiffness was assessed by the cardio-ankle vascular index (CAVI). Values are presented as Me [25; 75 percentiles].Results:
Before treatment (W0), MCA TAMX, Vps were increased during 2 minutes of CO2 inhalation, but did not return to baseline values in the recovery phase (Figure). Valsartan normalized both systolic and diastolic BP since the first month (P < 0.01). MCA TAMX and Vps did not differ significantly during CO2 inhalation between W0 and W24. Values of MCA blood flow velocities were significantly lower after valsartan treatment compared with W0 in the 3–5 minutes recovery period (P < 0.02). After valsartan treatment (W24), CAVI decreased from 8.1 [6.7; 10.5] to 7.9 [6.7; 11.6] (P < 0.01).Conclusions:
Valsartan treatment improved arterial stiffness and CVR in hypertensive patients with RA by normalizing the MCA blood flow velocities in the recovery phase of CO2 test.