Therapeutics Reduction in Arterial Stiffness With Angiotensin II Antagonism and Converting Enzyme Inhibition A Comparative Study Among Malay Hypertensive Subjects With a Known Genetic Profile Asia Rehman, Shaiful Bahari Ismail, Lin Naing, Tariq Mahmood Roshan, and Abdul Rashid Abdul Rahman Background: Data comparing the effect of losartan and perindopril on aortic stiffness among hypertensive subjects without A 1166 C polymorphism was not available. Methods: The short-term and long-term effects of losar- tan (50 mg) and perindopril (4 mg) on aortic stiffness mea- sured as carotid femoral pulse wave velocity (PWV) were compared in 39 middle-aged Malay subjects with mild-to- moderate hypertension in a 4-month, double-blind, random- ized, controlled, parallel-design study. Results: Four-month treatment with both drugs showed a significant reduction in blood pressure (BP) (P  .005) and PWV (P  .05) as compared to the baseline. On the other hand 1-month treatment showed a significant reduc- tion in BP only in perindopril group (P  .05) but not in the losartan group. There was no significant reduction in pulse pressure and PWV after 1 month treatment by both drugs. No significant difference was seen in reduction in BP after 1 month and 4 months treatment between the two drugs. Similarly no significant difference was seen in re- duction in PWV between the two drugs after 1 month (P = .613) and 4 months (P = .521) of treatment. Reduction in PWV by losartan (r = 0.470) and perindopril (r = 0.457) correlated significantly only with reduction in DBP (P  .05) and remained significant even after controlling for reduction in DBP (P  .05). Reduction in PWV by both losartan and perindopril was independent of reduction in BP by these drugs. Conclusions: These results showed that long-term treatment with losartan shows similar pressure indepen- dent reduction in PWV as perindopril among Malay hy- pertensive subjects with a homogenous “AA” genotype for angiotensin II type 1 receptor and may serve as a suitable alternative to perindopril. Am J Hypertens 2007;20: 184 –189 © 2007 American Journal of Hypertension, Ltd. Key Words: Aortic stiffness, pulse wave velocity, hy- pertension, renin angiotensin system, gene polymorphism, prindopril, losartan. L arge artery stiffness measured as carotid femoral pulse wave velocity (CF-PWV) is reported to be an inde- pendent marker of cardiovascular (CV) 1 and all-cause mortality, 2,3 coronary events 4 and fatal strokes in hyperten- sive individuals. 5 Arterial stiffness reduces with antihyperten- sive treatment, 6 thus reducing the associated CV risk. Studies also showed that an angiotensin II (Ang II) type 1 receptor (AT1R) gene A 1166 C polymorphism influences the reduc- tion in arterial stiffness in response to antihypertensive treatment. 7 Among antihypertensive drugs, beneficial ef- fects of ACE inhibitors on arterial stiffness are reported to be independent of blood pressure (BP) changes produced by the drug. 8 Similar pressure-independent effects were reported for Ang II receptor blockers (ARB), 9 which were comparable to those of the ACE inhibitors. 10 Both ACE inhibitors and ARB exert their beneficial effects on arterial stiffness by blockade of the deleterious effects of Ang II, the effector hormone of the renin-angiotensin system (RAS). Among various ACE inhibitors, perindopril is widely investigated for its beneficial effects on aortic PWV in both short- and long-term studies among hypertensive patients. Influence of perindopril on aortic PWV among hypertensive subjects with and without AT1R A 1166 C Received February 21, 2006. First decision July 18, 2006. Accepted July 19, 2006. From the School of Dental Sciences (AR, LN), University Sains Malaysia, Kelantan, Malaysia; School of Medical Sciences (SBI, TMR), University Sains Malaysia, Kelantan, Malaysia; and the College of Med- ical Sciences (ARAR), Cyberjaya University, Cyberjaya, Malaysia. Address correspondence and reprint requests to Dr. Asia Rehman, School of Dental Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia; e-mail: asia@kb.usm.my, asiarehman2002@ yahoo.com. AJH 2007; 20:184 –189 0895-7061/07/$32.00 © 2007 by the American Journal of Hypertension, Ltd. doi:10.1016/j.amjhyper.2006.07.015 Published by Elsevier Inc. Downloaded from https://academic.oup.com/ajh/article-abstract/20/2/184/181973 by guest on 08 June 2020