Angiotensin II receptor blocker prevents upper gastrointestinal bleeding in hypertensive patients with chronic kidney disease not on dialysis

Hypertension and Chronic Kidney Disease (CKD) is known as a major risk factor for cardiovascular disease (CVD). This study was designed to investigate endothelial function and long-term outcome of telmisartan, angiotensin II receptor blocker, in hypertensive patients with CKD. Seventy one untreated hypertensive patients with CKD (stage 3 or 4) were randomized to receive telmisartan ( Telmisartan group , n=35) or amlodipine ( Amlodipine group , n=36). Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) of brachial artery were measured by using ultrasound system. Pulse wave velocity (PWV) was measured by using oscilometric technique. We also measured high sensitivity C-reactive peptide (hsCRP) and thiobarbituric acid reactive substance (TBARS) as indexes of inflammation and oxidative stress. The primary outcome was death from CVD, or hospitalization for CVD during a follow-up period 4.2 to 4.7 years (median, 4.4 years). Blood pressure was significantly decreased in the both groups, and there was no difference between two groups at baseline and during study. FMD was significantly increased, and PWV, hsCRP, and TBARS were significantly decreased in the both groups after the treatment. However, these improvements were much better in the telmisartan group as compared with the amlodipine group. The 4.4-year cumulative primary-event rates were 12.6% in the telmisartan group and 37.4% in the amlodipine group (p=0.012 by long-lank test). Telmisartan improves not only endothelial function, PWV, hsCRP, or TBARS, but also long-term cardiovascular outcome in hypertensive patients with CKD.

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Renoprotective effects of angiotensin II receptor blocker, candesartan cilexetil, in patients with stage 4–5 chronic kidney disease

Clinical and Experimental Nephrology ◽

10.1007/s10157-008-0040-y ◽

2008 ◽

Vol 12 (4) ◽

pp. 256-263 ◽

Cited By ~ 6

Author(s):

Yoshifuru Tamura ◽

Masahiro Kosuga ◽

Masahiro Yamashita ◽

Satoru Tomioka ◽

Michiko Sasaki ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Angiotensin Ii ◽

Kidney Disease ◽

Candesartan Cilexetil ◽

Receptor Blocker ◽

Angiotensin Ii Receptor Blocker ◽

Angiotensin Ii Receptor ◽

Stage 4

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Effect of angiotensin II receptor blocker therapy on markers of fibrosis and immune inflammation in hypertensive patients with chronic kidney disease after ischemic stroke

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-3078 ◽

2021 ◽

Vol 20 (7) ◽

pp. 3078

Author(s):

O. A. Osipova ◽

E. V. Gosteva ◽

O. N. Belousova ◽

T. P. Golivets ◽

J. Yu. Chefranova ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Ischemic Stroke ◽

Angiotensin Ii ◽

Kidney Disease ◽

Angiotensin Ii Receptor Blocker ◽

Angiotensin Ii Receptor ◽

Blocker Therapy ◽

Hypertensive Patients ◽

Tnf Α ◽

Immune Inflammation

Aim. To compare the effect of angiotensin II receptor blocker therapy (azilsartan, telmisartan) on fibrosis and immune inflammation markers in hypertensive patients with chronic kidney disease (CKD) after ischemic stroke (IS).Material and methods. The study included 76 hypertensive patients aged 60-74 years (mean age, 66±5 years) with CKD after IS. Patients were randomly divided into following pharmacotherapy groups: 38 patients — telmisartan group; 36 patients — azilsartan group. The control group consisted of 20 hypertensive people (mean age, 63±2 years) without a history of CKD and IS. The levels of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were determined by enzyme-linked immunosorbent assay (ELISA Kit, USA). The levels of interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α), interferon γ (INF-γ), monocytic chemoattractant protein 1 (MCP-1) were assessed using Vector-Best kit (Russia).Results. Six-month azilsartan therapy led to a decrease in the levels of MMP-9 by 19,9% (p<0,01), TIMP-1 by 7,5% (p<0,05), IL-1β by 7,8%, TNF-α by 13,5%, INF-γ by 7,1%, MCP-1 by 13% (p<0,05). Telmisartan therapy was associated with a decrease in the levels of MMP-9 by 39,1% (p<0,01), TIMP-1 by 16,4%, IL-1β by 10,1% (p<0,05), TNF-α by 20,8% (p<0,01), INF-γ by 14,6% (p<0,05), MCP-1 by 21,3% (p<0,01). Intergroup comparison revealed more pronounced changes in the levels of MMP-9 by 19,2% (p<0,01), TIMP-1 by 7,2% (p<0,05), TNF-α by 7,3% (p<0,05), INF-γ by 7,5% (p<0,05), and MCP-1 by 8,3% (p<0,05) when using telmisartan compared to azilsartan. When using telmisartan, the increase in glomerular filtration rate (GFR) was 14,2% (p<0,05) higher compared to azilsartan.Conclusion. Six-month telmisartan therapy in hypertensive patients with CKD after stroke was accompanied by a more pronounced decrease in markers of myocardial fibrosis (MMP-9, TIMP-1) and immune inflammation (TNF-α, INF-γ, MCP-1) compared with azilsartan, as well as with more pronounced improvement in renal function.

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