The Clinical Pharmacy Specialists’ Role in Antihypertensive Management Surrounding Bariatric Surgery in a Veterans Affairs Population

Background: No guidelines exist for de-escalating antihypertensive medications surrounding bariatric surgery. This study analyzed clinical pharmacy specialist (CPS) management of antihypertensive medications in patients undergoing bariatric surgery at a Veterans Affairs medical center. Objectives: The primary objective was to describe the CPS role in antihypertensive management surrounding bariatric surgery through evaluation of number of CPS encounters, number and type of antihypertensive medications and medication interventions by CPSs and all other providers, over 5 time periods between a pre-operative assessment and up to 6 months post-operatively. Methods: Electronic medical records of patients taking antihypertensive medication who underwent bariatric surgery between 1/1/2014 and 2/27/2018, had primary care through our facility, and at least 1 encounter with a CPS were reviewed. Results: Forty patients were included out of 221 screened. There were 109 total medication interventions in 37 patients. CPSs provided 60 medication interventions (55% of total interventions) in 26 patients. Mean antihypertensive agents per patient was 2.18 at baseline versus 0.95 at 6-months post-operative. Dihydropyridine calcium channel blockers had the highest discontinuation rate. Thiazide diuretics were most commonly discontinued prior to surgery and angiotensin converting enzyme inhibitors were discontinued more steadily over the study duration. Nineteen patients (48.7%) had blood pressure <140/90 mmHg and were off all antihypertensive medications at the final CPS encounter. Conclusion: The results of this small study support the role of CPSs in antihypertensive medication management surrounding bariatric surgery.

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Use of Antihypertensive and Antithrombotic Medications after Stroke in Community-Based Care

Annals of Pharmacotherapy ◽

10.1345/aph.10341 ◽

2001 ◽

Vol 35 (7-8) ◽

pp. 811-816 ◽

Cited By ~ 8

Author(s):

Sally K Rigler ◽

Melissa J Webb ◽

Atul T Patel ◽

Sue Min Lai ◽

Pamela W Duncan

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Antihypertensive Medication ◽

Medication Use ◽

Antihypertensive Agents ◽

Channel Blockers ◽

Community Based ◽

Converting Enzyme Inhibitors ◽

Stroke Study ◽

Blood Pressures

BACKGROUND: Secondary stroke prevention strategies include pharmacologic approaches to control hypertension and reduce thromboembolic risk. OBJECTIVE: To describe antithrombotic and antihypertensive medication use, and rates of blood pressure control in the Kansas City Stroke Study, a prospective stroke cohort receiving community-based care after primarily mild and moderate stroke. METHODS: Participants from 12 area hospitals provided information about medication use prior to stroke. Study personnel measured blood pressures at enrollment and at one, three, and six months, and collected medication data at six months during in-home assessment. RESULTS: Complete data at six months were available for 355 subjects with ischemic stroke, among whom 13% had atrial fibrillation and 67% had prior hypertension. Prior to stroke, only 45% of the patients were receiving any antithrombotic (anticoagulant and/or antiplatelet) therapy; this figure rose to 77% at six months. Antithrombotic treatment rates among those with atrial fibrillation were 59% before stroke and 83% at six months, including warfarin in 64%. Approximately 70% of subjects had controlled blood pressures one, three, and six months after stroke, defined as systolic blood pressure ≤140 mm Hg and diastolic blood pressure ≤90 mm Hg. Use of multiple antihypertensive agents was common; calcium-channel blockers and angiotensin-converting enzyme inhibitors were used most frequently. However, 19% of subjects with uncontrolled blood pressure were untreated at six months. CONCLUSIONS: Although room for improvement remains, these data suggest improved rates of antithrombotic and antihypertensive medication use after stroke in community-based care in a midwestern metropolitan community, compared with previous reports.

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Abstract 3783: Antihypertensive Medications in the Department of Veterans Affairs (VA) 1999–2006

Circulation ◽

10.1161/circ.116.suppl_16.ii_860-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Julio R Lopez ◽

Sonya Wong ◽

Joy L Meier ◽

Fran Cunningham ◽

David Siegel

Keyword(s):

Antihypertensive Medication ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Medication Use ◽

Angiotensin Converting Enzyme Inhibitors ◽

Steady Increase ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed. Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel blockers (CCB), thiazide diuretics (TD) alone or with K sparing diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and combinations of the aforementioned classes for 2003–2006. Total number of treatment days, determined from days supply of the prescription, was used to determine patterns of use over time. Results: Antihypertensive medication use in the VA represented more than 1.5 billion days in 2006 and increased 2.5 fold from the 577 million estimated for 1999. ACEI were most commonly used, representing 31.8% and 31.7% of treatment days in 1999 and 2006, respectively. In the ACEI class lisinopril is the most commonly used drug. Increases in use from 1999 to 2006 were 21.2% to 25.2% for BB, 14.4% to 17.8% for TD, and 1.2% to 5.2% for ARB. Decreases in use from 1999 to 2006 were 26.7% to 17.6% for CCB. The decline in CCB was inversely correlated to the increase in BB or TD (p<0.001). Shifts in medication use are estimated to save the VA $33 million annually. Conclusions: ACEI remain the most prescribed antihypertensive drug class in the VA, followed by BB, TD, CCB, and ARBs. TD use shows a slow steady increase while CCB use continues to decline. These findings suggest that VA has increasing adherence to JNC7 and VA HTN guidelines.

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Pattern of Medication Prescribing and Factors Associated with Meeting of Target Blood Pressure among Persons with Hypertension in Federal Police Referral Hospital, Ethiopia

Annals of Advanced Biomedical Sciences ◽

10.23880/aabsc-16000124 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Tariku Shimels

Keyword(s):

Blood Pressure ◽

Antihypertensive Agents ◽

Structured Interview ◽

Referral Hospital ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

Cross Sectional ◽

Factors Associated ◽

Study Participants

Introduction: Hypertension is one of the highly growing chronic health challenges worldwide causing a significant number of deaths and cardiovascular complications. The prevalence of the condition in Ethiopia was estimated to be 19.5% with an urban and rural subgroup proportion of 25.7% and 14.7% respectively. This study was conducted to assess the pattern of prescribing antihypertensive medications and factors associated with BP target meeting among persons with hypertension in Federal Police Referral Hospital. Method: An institution based cross sectional study was conducted from 15th October 2016 to 15th January 2017. A systematic random sampling technique was employed in selecting the study participants. Data was collected using a semi-structured interview of study participants and visiting medication records. SPSS version 20 was used for data entry and analysis. Results: Of the 330 subjects required to be included in the study, 318 (96.4%) fulfilled the inclusion criteria and were considered for further analysis. Diuretics were the top prescribed class of antihypertensive agents accounted by 201(63.2%) of the subjects. Hydrochlorothiazide, a thiazide diuretic, was the most frequent. Next highly utilized classes of drugs included; calcium channel blockers among 172 (54.1%) subjects followed by angiotensin converting enzyme inhibitors prescribed for 153 (48.1%) participants. Target meeting for the systolic and diastolic blood pressure accounted for 142 (44.7%) and 140(44%) of the study subjects respectively. Overall target meeting of the two variables was attained by 103(32.4%) of the participants. Conclusion: Diuretics were the class of drugs most frequently prescribed succeeded by CCBs and ACEIs. The result of this study has also shown that overall BP target meeting among the subjects was suboptimal. Multivariate binary logistic regression has shown that gender, duration of therapy and dietary adherence were associated with BP target meeting.

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Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10040771 ◽

2021 ◽

Vol 10 (4) ◽

pp. 771

Author(s):

In-Jeong Cho ◽

Jeong-Hun Shin ◽

Mi-Hyang Jung ◽

Chae Young Kang ◽

Jinseub Hwang ◽

...

Keyword(s):

Antihypertensive Drugs ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

Incident Cancer ◽

Increased Risk ◽

Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

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Risk of Cerebral Hypoperfusion with Antihypertensive Therapy

DICP ◽

10.1177/106002808902301201 ◽

1989 ◽

Vol 23 (12) ◽

pp. 957-962 ◽

Cited By ~ 5

Author(s):

Susan C. Eagan ◽

Lance W. Payne ◽

Susan C. Houtekier

Keyword(s):

Antihypertensive Therapy ◽

Antihypertensive Medication ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Angiotensin Converting Enzyme Inhibitors ◽

Cerebral Hypoperfusion ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Populations At Risk ◽

Treatment Of Hypertension

The effective treatment of hypertension is a major factor in the declining incidence of stroke in North America. There are subsets of patients, however, in which antihypertensive therapy may actually cause cerebral ischemia and infarction. Elderly patients and those with malignant hypertension, acute stroke, and occlusive cerebrovascular disease appear to be the populations at greatest risk of iatrogenic stroke. This article reviews the effect of beta-blockers, angiotensin-converting enzyme inhibitors, direct vasodilators, and calcium-channel blockers on cerebral blood flow in various populations. Although many investigations have been performed, it remains difficult to predict the risk of cerebral hypoperfusion due to antihypertensive medication in an individual patient. It is best for practitioners to be aware of the patient populations at risk and treat high blood pressure cautiously in these patients.

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P1006IMPACT OF GLUCOSE-LOWERING AND ANTIHYPERTENSIVE MEDICATIONS ON DEVELOPMENT OF MICROALBUMINURIA IN SUBJECTS WITH TYPE 2 DIATETES AND NORMOALBUMINURIA IN THE PRIORITY STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1006 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Nete Tofte ◽

Morten Lindhardt ◽

Gemma Currie ◽

Marie Frimodt-Moeller ◽

Heiko Von der Leyen ◽

...

Keyword(s):

High Risk ◽

Cox Model ◽

Controlled Trial ◽

Low Risk ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

Glucose Lowering ◽

Increased Risk ◽

Dipeptidyl Peptidase 4 Inhibitors

Abstract Background and Aims In the PRIORITY study, it was recently demonstrated that the urinary peptidome-based classifier CKD273 was associated with increased risk for progression to microalbuminuria. In this sub-study, we aim to evaluate whether glucose-lowering and antihypertensive medications, many of which have been demonstrated to have albuminuria-lowering effects, may interfere with the predictive value of CKD273. Method A post hoc analysis of a prospective observational study with embedded randomised placebo-controlled trial. Setting 1775 subjects from 15 European sites with a mean follow-up time of 2.6 years (minimum of 7 days and a maximum of 4.3 years). Patients Subjects with T2D, normoalbuminuria and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73m2. Participants were stratified into high- or low-risk groups based on their CKD273 score in a urine sample at screening (high-risk defined as score > 0.154). Main outcome measures Baseline medication or initiation during the study was assessed for the following medications: glitazones, glucagon-like peptide-1 receptor agonists (GLP1-RA), sodium-glucose cotransporter-2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP4i), angiotensin-converting-enzyme inhibitors (ACEi), angiotensin-II-receptor blockers (ARB), calcium channel blockers (CCB) and beta blockers (BB). The main outcome was development of confirmed microalbuminuria (urinary albumin to creatinine ratio (UACR) >30 mg/g and with ≥30% increase from baseline) in 2 of 3 consecutive samples. Results The hazard ratio (HR (95% CI)) for development of microalbuminuria (high vs. low-risk) was 3.9 (2.9-5.3) in a crude Cox-model; and 2.4 (1.8-3.4; p<0.0001) when adjusted for age, sex, HbA1c, systolic blood pressure, retinopathy, eGFR and UACR. Adding baseline medications to the model did not significantly alter the results. When evaluating medications initiated during the study, more high- than low-risk subjects were started on glitazones, GLP1-RA, SGLT2i, CCB and BB (p<0.03), however, only initiation of DPP4i was associated with the outcome. Adjustment for DPP4i initiated during the study did not significantly change the HR for development of confirmed microalbuminuria (HR 2.5 (1.8 to 3.4); p<0.0001) in a model including eGFR and UACR. The HR for development of persistent microalbuminuria (spironolactone vs. placebo) was 0.81 (0.49-1.34; p=0.41), however, adjusting for DPP4i did not significantly alter this result. Conclusion Although several glucose-lowering and antihypertensive medications were more frequently prescribed in high-risk subjects, the CKD273 classifier prospectively predicted confirmed microalbuminuria, independent of baseline co-medications and medication initiated during the study. Moreover, initiated medications during the study could not explain the inability of spironolactone to delay progression to microalbuminuria.

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Primary stroke prevention and hypertension treatment: which is the first-line strategy?

Neurology International ◽

10.4081/ni.2011.e12 ◽

2011 ◽

Vol 3 (2) ◽

pp. 12 ◽

Cited By ~ 16

Author(s):

Roberta Ravenni ◽

Joe Jabre ◽

Edoardo Casiglia ◽

Alberto Mazza

Keyword(s):

Stroke Prevention ◽

Enzyme Inhibitors ◽

Antihypertensive Agents ◽

Clinical Intervention ◽

Vascular Risk Factor ◽

Angiotensin Converting Enzyme Inhibitors ◽

Fixed Dose ◽

Channel Blockers ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors

Hypertension (HT) iis considered the main classic vascular risk factor for stroke and the importance of lowering blood pressure (BP) is well established. However, not all the benefit of antihypertensive treatment is due to BP reduction <em>per se</em>, as the effect of reducing the risk of stroke differs among classes of antihypertensive agents. Extensive evidences support that angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), dihydropyridine calcium channel blockers (CCB) and thiazide diuretics each reduced risk of stroke compared with placebo or no treatment. Therefore, when combination therapy is required, a combination of these antihypertensive classes represents a logical approach. Despite the efficacy of antihypertensive therapy a large proportion of the population, still has undiagnosed or inadequately treated HT, and remain at high risk of stroke. In primary stroke prevention current guidelines recommend a systolic/diastolic BP goal of <140/<90 mmHg in the general population and <130/80 mmHg in diabetics and in subjects with high cardiovascular risk and renal disease. The recent release in the market of the fixed-dose combination (FDC) of ACEI or ARB and CCB should provide a better control of BP. However to confirm the efficacy of the FDC in primary stroke prevention, clinical intervention trials are needed.

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Abstract P049: Race/Ethnic Differences in Patterns of Antihypertensive Medication Uptake and Clinical Outcomes among Hospitalized Diabetic Patients with Hypertension

Circulation ◽

10.1161/circ.129.suppl_1.p049 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Heidi Mochari-Greenberger ◽

Lori Mosca

Keyword(s):

Calcium Channel ◽

Clinical Outcomes ◽

Ethnic Differences ◽

Beta Blocker ◽

Antihypertensive Medication ◽

Diabetic Patients ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Lower Odds ◽

Race Ethnicity

Background: Hypertension increases the risk of complications in patients with diabetes. Race/ethnic differences in the uptake of antihypertensive medications may contribute to disparities in clinical outcomes, but this has not been formally evaluated. We aimed to assess patterns of antihypertensive medication prescription by race/ethnic group and the association with clinical outcomes among hospitalized diabetic patients with hypertension. Methods: This was a 1 year prospective study of individuals with existing diabetes and hypertension (N=1126, 42% black/Hispanic [minority]; 39% female) that participated in an NHLBI clinical outcomes study of patients admitted to a cardiovascular service. Baseline clinical/medication data and outcomes (rehospitalization/death) were documented by electronic medical record, National Death Index, and standardized mail survey. Logistic regression was used to evaluate associations between race/ethnicity, antihypertensive prescription, and outcomes adjusted for demographics/comorbidities. Results: Overall utilization of antihypertensive medication prior to admission did not differ between minority (92%) vs. white/other (93%) patients; minorities were more likely to report taking calcium channel blockers (OR=1.40;95%CI=1.08-1.81) and less likely to use beta blockers (OR=0.65;95%CI=0.50-0.84) vs. whites/others. Race/ethnic differences in prescription type did not persist at discharge after adjustment for demographics/comorbidities (96% prescribed any antihypertensive medication: 62% ACE inhibitor/ARB, 81% beta blocker, 29% calcium channel blocker, 48% diuretic). A total of 676 (60%) of participants were rehospitalized/dead at 1 year; predictors of rehospitalization/death included minority race/ethnicity, lack of health insurance, renal failure/dialysis, peripheral vascular disease, and heart failure (p<0.05). Prescription of beta blocker (OR=0.60;95%CI=0.43-0.82) was associated with lower odds of rehospitalization/death at 1 year. Race/ethnic minority status remained a significant predictor of death/rehospitalization at 1 year after adjustment demographics, comorbidities and beta blocker prescription at discharge (OR=1.31;95%CI=1.01-1.71). Conclusion: In this study of hospitalized diabetic patients with hypertension, antihypertensive prescription at discharge did not vary by race/ethnicity; beta blocker prescription at discharge was associated with lower odds of rehospitalization/death at 1 year. Higher odds of rehospitalization/death among minorities was not explained by measured covariates including type of antihypertension medication.

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Abstract 137: Comparing Blood Pressure Control in Diabetic Versis Nondiabetic Veterans Following Percutaneous Coronary Intervention

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a137 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Karthik Challa ◽

Amit Ladani ◽

Sloane McGraw ◽

Anupama Shivaraju ◽

Adhir Shroff

Keyword(s):

Lifestyle Modification ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Coronary Intervention ◽

National Committee ◽

Diabetic Patients ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors ◽

The Mean

Background: As per the US Joint National Committee VII (JNC-7) recommendations, patients with known underlying coronary artery disease and diabetes should have goal blood pressures (BP) of systolic (SBP) <130 and diastolic (DBP) <80 to decrease morbidity and mortality associated with cardiovascular disease. In addition to lifestyle modification, these goals can be attained by use of multiple classes of drugs including beta-blockers (BB), angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of the JNC-7 guidelines, comparing outcomes between 355 diabetic to 580 non-diabetic patients undergoing PCI between September 2004 and January 2011 at the Jesse Brown Veterans Affairs Hospital in Chicago, IL. BP measurements and antihypertensive medications pre and post PCI at 6-month follow-up were documented. Results: Among the diabetic population, the mean SBP decreased from 136 to 131 mmHg (p = 0.0007) and mean DBP decreased from 73 to 70 mmHg (p = 0.0005). In the non-diabetics, the mean SBP decreased from 133 to 127 mmHg (p < 0.0001) and the mean DBP decreased from 73 to 70 mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of diabetics at SBP goal increased from 39% to 49% (p = 0.0053) and percent at DBP goal increased from 73% to 82% (p = 0.0098). In non-diabetics, percent at goal for SBP increased from 45% to 57% (p < 0.0001) and percent at DBP goal increased from 68% to 76% (p = 0.0009). Among diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 79% to 92%. In non-diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 66% to 87% and ACE-I/ARB from 51% to 70%. Conclusions: In both groups undergoing PCI, SBP and DBP improved with more patients achieving JNC-7 targets. Among diabetics, there was a significant increase in utilization of BB. Among non-diabetics, there was a significant increase in utilization of BB and ACE-I/ARB.

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A Study of Morphological Changes in Renal Afferent Arterioles Induced by Angiotensin II Type 1 Receptor Blockers in Hypertensive Patients

Kidney & Blood Pressure Research ◽

10.1159/000505025 ◽

2020 ◽

Vol 45 (2) ◽

pp. 194-208 ◽

Cited By ~ 1

Author(s):

Yohko Nagai ◽

Fumito Yamabe ◽

Yosuke Sasaki ◽

Takamasa Ishii ◽

Kazushige Nakanishi ◽

...

Keyword(s):

Angiotensin Ii ◽

Enzyme Inhibitor ◽

Morphological Changes ◽

Medical Center ◽

Statistical Significance ◽

Antihypertensive Agents ◽

Channel Blockers ◽

Hypertensive Patients ◽

Receptor Blockers

Background: Renin-angiotensin-aldosterone system blockers are known to reduce hypertrophy of vascular smooth muscle cells (SMCs) in hypertensive cases. However, we have reported marked proliferative changes of renal afferent arteriolar SMCs in rats induced by a long-term administration of angiotensin II type 1 receptor blockers (ARBs) and an angiotensin-converting enzyme inhibitor (ACEI). In this study, we examined the morphological changes of afferent arteriolar walls in human kidneys with or without ARBs/ACEIs. Methods: Forty-four wedge resections were taken from patients aged 45–74 years from 92 nephrectomized kidneys due to malignancy at Toho University Omori Medical Center between 2013 and 2016. They were divided into the following three groups: 18 hypertensive patients treated with antihypertensive agents including ARBs or ACEIs (the HTARB group), 6 hypertensive patients treated with calcium channel blockers without ARBs/ACEIs (the HTCCB group), and 20 normotensive patients (the normotensive group) as a control. Cases expecting vascular changes such as diabetes were excluded. In each case renal arterioles were measured as the ratio of inner/outer arteriolar diameter, and pathologists estimated morphological abnormal changes, scoring each specimen independently. Results: The ratio in the HTARB group was 0.39 ± 0.05 (mean ± SD), and was significantly the lowest among the three groups (0.46 ± 0.02 in the HTCCB, 0.53 ± 0.02 in the normotensive group; p = 0.0107 vs. HTCCB, p = 0.00001 vs. normotensive). The ratio in the three groups significantly correlated with the estimated glomerular filtration rate (r = 0.4915, p < 0.0007). The afferent arteriolar SMCs in the HTARB group frequently showed marked proliferative and irregular changes. The score of SMC abnormalities estimated regarding the proliferation, irregularity of the arrangement, and size in hilar afferent arteriolar SMCs was highest in the HTARB group and showed statistical significance (p = 0.0088, p = 0.00001, and p = 0.025 versus other two groups). Conclusions: We consider that these morphological changes in arterioles are induced by ARBs/ACEIs. These changes could induce an important suppression of glomerular hyperfiltration and could lead to glomerular ischemia. However, the clinical consequences of these morphological changes in correlation with ARBs/ACEIs were not sufficiently clear and require further analysis. We should consider renal arteriolar morphological changes when using ARBs/ACEIs.

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