nach oben

Cardiovascular Drugs and Therapy

Erschienen in:

01.08.2010

Is Vascular Stiffness a Target for Therapy?

verfasst von: Daniel A. Duprez

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 4/2010

Einloggen, um Zugang zu erhalten

Abstract

Background

Early cardiovascular disease starts in the endothelium leading to functional changes in the vasculature. These changes can be depicted by assessment of arterial stiffness or elasticity. There are several techniques to assess arterial stiffness. Increased arterial stiffness or decreased arterial elasticity has been associated with cardiovascular risk factors. There is now evidence that small artery elasticity is a strong predictor for arterial hypertension. Moreover arterial elasticity provides extra prognostic information beyond arterial blood pressure measurement. Arterial stiffness attenuation may reflect the true reduction of arterial wall damage.

Results

ACE-inhibitors, angiotensin II receptor blockers, aldosterone antagonists and calcium antagonists have favorable effects in improving arterial elasticity, while beta-blockers have an inverse effect. Diuretics have not been evaluated. Lipid lowering therapy, some antidiabetic therapy have shown to reduce arterial stiffness. Inflammatory and infectious diseases have been associated with vascular inflammation and consequently increase in arterial stiffness. The effect of anti-inflammatory agents and antiretroviral therapy on arterial stiffness is under investigation.

Conclusions

Measurement of arterial stiffness will not only be helpful in the detection of early vascular disease but also as a tool in the selection and follow-up monitoring of therapeutic strategies aimed at preventing or delaying progression of vascular disease.

Nilsson PM, Lurbe E, Laurent S. The early life origins of vascular ageing and cardiovascular risk: the EVA syndrome. J Hypertens. 2008;26:1049–57.CrossRefPubMed

Pepine CJ. The impact of nitric oxide in cardiovascular medicine: untapped potential utility. Am J Med. 2009;122:S10–5.CrossRefPubMed

Duprez DA, Cohn JN. Identifying early cardiovascular disease to target candidates for treatment. J Clin Hypertens (Greenwich). 2008;10:226–31.CrossRef

Cohn JN, Duprez DA, Finkelstein SM. Comprehensive noninvasive arterial vascular evaluation. Future Cardiol. 2009;5:573–9.CrossRefPubMed

Cohn JN. Vascular wall function as a risk marker for cardiovascular disease. J Hypertens Suppl. 1999;17:S41–4.CrossRefPubMed

Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al. Health ABC Study. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation. 2005;111:3384–90.CrossRefPubMed

Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113:664–70.CrossRefPubMed

Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113:657–63.CrossRefPubMed

Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME. Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol. 2001;21:2046–50.CrossRefPubMed

10.

Shokawa T, Imazu M, Yamamoto H, Toyofuku M, Tasaki N, Okimoto T, et al. Pulse wave velocity predicts cardiovascular mortality: findings from the Hawaii-Los Angeles-Hiroshima study. Circ J. 2005;69:259–64.CrossRefPubMed

11.

Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J. 2010, Mar 2. [Epub ahead of print].

12.

Finkelstein SM, Cohn JN. First- and third-order models for determining arterial compliance. J Hypertens Suppl. 1992;10:S11–4.CrossRefPubMed

13.

Duprez DA, Cohn JN. Arterial stiffness as a risk factor for coronary atherosclerosis. Curr Atheroscler Rep. 2007;9:139–44.CrossRefPubMed

14.

Nakayama Y, Tsumura K, Yamashita N, Yoshimaru K, Hayashi T. Pulsatility of the ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. Circulation. 2000;101:470–2.PubMed

15.

Weber T, Auer J, O’Rourke MF, Kvas E, Lassnig E, Lamm G, et al. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J. 2005;26:2657–63.CrossRefPubMed

16.

Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106:2085–90.CrossRefPubMed

17.

Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99:2434–9.PubMed

18.

Grey E, Bratteli C, Glasser SP, et al. Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events. Am J Hypertens. 2003;16:265–9.CrossRefPubMed

19.

Stamler J, Neaton JD. The Multiple Risk Factor Intervention Trial (MRFIT)—importance then and now. JAMA. 2008;300:1343–5.CrossRefPubMed

20.

Giles TD, Materson BJ, Cohn JN, Kostis JB. Definition and classification of hypertension: an update. J Clin Hypertens (Greenwich). 2009;11:611–4.CrossRef

21.

Peralta CA, Adeney KL, Shlipak MG, Jacobs Jr D, Duprez D, Bluemke D, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2010;171:63–71.CrossRefPubMed

22.

Winer N, Weber MA, Sowers JR. The effect of antihypertensive drugs on vascular compliance. Curr Hypertens Rep. 2001;3:297–304.CrossRefPubMed

23.

Mallareddy M, Parikh CR, Peixoto AJ. Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2006;8:398–403.CrossRef

24.

Vyssoulis GP, Karpanou EA, Kyvelou SM, Adamopoulos DN, Antonakoudis GC, Deligeorgis AD, et al. Beneficial effect of angiotensin II type 1 receptor blocker antihypertensive treatment on arterial stiffness: the role of smoking. J Clin Hypertens (Greenwich). 2008;10:201–7.CrossRef

25.

Duprez DA, Florea ND, Jones K, Cohn JN. Beneficial effects of valsartan in asymptomatic individuals with vascular or cardiac abnormalities: the DETECTIV Pilot Study. J Am Coll Cardiol. 2007;50:835–9.CrossRefPubMed

26.

White WB, Duprez D, St Hillaire R, Krause S, Roniker B, Kuse-Hamilton J, et al. Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension. Hypertension. 2003;41:1021–6.CrossRefPubMed

27.

Cohn JN, Wilson DJ, Neutel J, Houston M, Weinberger MH, Grimm Jr R, et al. Coadministered amlodipine and atorvastatin produces early improvements in arterial wall compliance in hypertensive patients with dyslipidemia. Am J Hypertens. 2009;22:137–44.CrossRefPubMed

28.

Mahmud A, Feely J. Antihypertensive drugs and arterial stiffness. Expert Rev Cardiovasc Ther. 2003;1:65–78.CrossRefPubMed

29.

Resnick LM, Lester MH. Differential effects of antihypertensive drug therapy on arterial compliance. Am J Hypertens. 2002;15:1096–100.CrossRefPubMed

30.

Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906.CrossRefPubMed

31.

Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes. Circulation. 2006;113:1213–5.CrossRefPubMed

32.

Duprez DA. Role of the renin-angiotensin-aldosterone system in vascular remodeling and inflammation: a clinical review. J Hypertens. 2006;24:983–91.CrossRefPubMed

33.

Schiffrin EL. Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens. 2004;17:1192–200.CrossRefPubMed

34.

Bakris G. An in-depth analysis of vasodilation in the management of hypertension: focus on adrenergic blockade. J Cardiovasc Pharmacol. 2009;53:379–87.CrossRefPubMed

35.

Grossman E, Messerli FH. Long-term safety of antihypertensive therapy. Prog Cardiovasc Dis. 2006;49:16–25.CrossRefPubMed

36.

Duprez DA, Cohn JN. Monitoring vascular health beyond blood pressure. Curr Hypertens Rep. 2006;8:287–91.CrossRefPubMed

37.

Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Endothelial function, arterial stiffness and lipid lowering drugs. Expert Opin Ther Targets. 2007;11:1143–60.CrossRefPubMed

38.

Goldberg RB. Thiazolidinediones and vascular damage. Curr Opin Endocrinol Diabetes Obes. 2007;14:108–15.PubMed

39.

Crilly MA, Kumar V, Clark HJ, Scott NW, Macdonald AG, Williams DJ. Arterial stiffness and cumulative inflammatory burden in rheumatoid arthritis: a dose-response relationship independent of established cardiovascular risk factors. Rheumatology (Oxford). 2009;48:1606–12.CrossRef

40.

Baker JV, Duprez D, Rapkin J, Hullsiek KH, Quick H, Grimm R, et al. Untreated HIV infection and large and small artery elasticity. J Acquir Immune Defic Syndr. 2009;52:25–31.CrossRefPubMed

Titel: Is Vascular Stiffness a Target for Therapy?
verfasst von: Daniel A. Duprez
Publikationsdatum: 01.08.2010
Verlag: Springer US
Erschienen in: Cardiovascular Drugs and Therapy / Ausgabe 4/2010
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI: https://doi.org/10.1007/s10557-010-6250-z

Neu im Fachgebiet Kardiologie

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2010

Atherosclerotic Plaque Regression: Fact or Fiction?

Conventional and Novel Drug Therapeutics to Relief Myocardial Ischemia

Aldosterone Inhibition and Cardiovascular Protection: More Important Than it Once Appeared

Smoking Cessation–Recent Advances