Outpatient Renal Clinic, University Hospital of Ioannina, Greece.
J Renin Angiotensin Aldosterone Syst. 2013 Dec;14(4):315-21. doi: 10.1177/1470320312465219. Epub 2012 Nov 6.
Blockade of the renin-angiotensin system (RAS) is a critical approach to the management of hypertension, especially in proteinuric patients. It is well proven that the direct renin inhibitor aliskiren shows comparable clinical efficacy to the angiotensin II receptor blocker valsartan on blood pressure control and albuminuria. However, there is only limited data on the hand-to-hand effectiveness of these two RAS blockers in improving arterial stiffness. We tested whether aliskiren or valsartan would improve arterial stiffness in hypertensive patients with albuminuria who are already on antihypertensive therapy.
Thirty-four patients with hypertension and albuminuria < 1 g, after a wash-out period of three weeks, were randomized to aliskiren or valsartan in a 24-week randomized parallel-group study.
A nonsignificant difference in blood pressure was seen between the two treatment groups. Albuminuria was significantly reduced in both groups (56% for the aliskiren group, p < 0.05, and 38% for the valsartan group, p < 0.05). Only valsartan but not aliskiren significantly reduced carotid-femoral pulse wave velocity (-1.1 ± 0.8 m/s (p = 0.02) for valsartan and +0.1 ± 0.7 m/s (ns) for aliskiren).
The results of our study showed that valsartan improves arterial stiffness to a significantly greater extent than aliskiren, despite a similar antihypertensive and antiproteinuric effect.
阻断肾素-血管紧张素系统（RAS）是治疗高血压的关键方法，尤其是在蛋白尿患者中。已有充分证据表明，直接肾素抑制剂阿利克仑在控制血压和蛋白尿方面与血管紧张素 II 受体阻滞剂缬沙坦具有相当的临床疗效。然而，关于这两种 RAS 阻滞剂在改善动脉僵硬度方面的实际效果，仅有有限的数据。我们检验了在已经接受降压治疗的伴蛋白尿的高血压患者中，阿利克仑或缬沙坦是否会改善动脉僵硬。
34 名高血压合并白蛋白尿<1g 的患者在经过三周洗脱期后，被随机分为阿利克仑或缬沙坦组，进行为期 24 周的平行分组随机研究。
两组患者的血压均无显著差异。两组患者的蛋白尿均显著减少（阿利克仑组减少 56%，p<0.05，缬沙坦组减少 38%，p<0.05）。只有缬沙坦而非阿利克仑能显著降低颈股脉搏波速度（缬沙坦组降低-1.1±0.8m/s，p=0.02，阿利克仑组增加 0.1±0.7m/s，无统计学意义）。
我们的研究结果表明，尽管降压和降蛋白尿效果相似，缬沙坦改善动脉僵硬的程度明显大于阿利克仑。
