Vascular age, as assessed by structural and functional properties of the arteries, is an important prognostic risk factor for cardiovascular events. Antihypertensive treatment has shown beneficial effects on prognosis through blood reduction. The aim of this study was to investigate the effect of different classes of antihypertensive drugs on the progression of vascular stiffening.Design and method:
One hundred and forty-two subjects (mean age 51.9 ± 10.8 years, 94 men, 61 hypertensives) with no established cardiovascular disease were investigated in two examinations over a 2-year period (mean follow-up visit 1.84 years). All hypertensives were under treatment for at least 1 year and had well-controlled blood pressure. Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave velocity (PWV). Based on these measurements the annual absolute changes were calculated.Results:
At baseline PWV was not statistically different between patients with and without hypertension (7.14m/s vs. 7.26m/s, P = 0.447). Subjects with hypertension had a gradual higher annual progression of PWV compared to subjects without hypertension [0.281 m/s/year (95% CI: 0.183–0.379) vs. 0.102 m/s/year (95% CI: 0.020–0.185), P = 0.013]. Treatment with angiotensin receptor blockers was associated with slower progression of arterial stiffening after adjustment for relevant confounders [0.03m/s/year (95% CI:-0.12 to 0.18) vs. 0.23m/s/year (95% CI: 0.15 to 0.30), P = 0.032]. Angiotensin converting enzyme inhibitors did not attenuate the hypertension-related progression of aortic stiffness [0.33m/s/year (95% CI: 0.15 to 0.50) under treatment vs. 0.15m/s/year (95% CI: 0.09 to 0.22), P = 0.08]. Neither beta-blockers [0.24m/s/year (95% CI:0.08 to 0.41) under treatment vs. 0.17m/s/year (95% CI:0.10 to 0.23), P = 0.42], calcium channel blockers [0.11m/s/year (95% CI:-0.04 to 0.27) under treatment vs. 0.20m/s/year (95% CI:0.13 to 0.27), P = 0.35] or thiazide diuretics [0.31m/s/year (95% CI:0.12 to 0.49) under treatment vs. 0.16m/s/year (95% CI:0.09 to 0.23), P = 0.16] showed beneficial effect on reversing progression of aortic stiffening.Conclusions:
Angiotensin receptor blockers may slow down progression of vascular stiffening more effectively compared to other classes of antihypertensive drugs independently of blood pressure reduction. These results warrant further confirmation in larger outcome studies.