The Influence of a Direct Renin Inhibitor on the Central Blood Pressure

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Background: Central blood pressure (CBP) is superior to brachial blood pressure as a predictor of cardiovascular risk in patients with hypertension. There is currently no consensus regarding whether a direct renin inhibitor (DRI) selectively acts on CBP.<br> Methods: Thirty subjects with essential hypertension who showed a CBP of 140 mm Hg or higher after 12 weeks of treatment with a standard dose of a DRI (150 mg) were analyzed. The patients were randomly divided into 2 groups: the high-dose DRI group (n=15) received 300 mg of DRI per day, and the combination group (n=15) received both the standard dose of the DRI and a diuretic (12.5 mg of hydrochlorothiazide). The systolic blood pressure (SBP), CBP, and the augmentation index (AI) were determined before treatment and after 12 and 24 weeks of treatment.<br> Results: The SBP, CBP and AI were significantly decreased after 12 weeks of treatment with standard dose of the DRI (p<0.05). From 12 to 24 weeks after assignment the SBP and CBP were also significantly decreased in both the high-dose DRI group and the combination group. The high-dose DRI group showed a greater decrease in the CBP, but not in the SBP, than did the combination group (p<0.05). The AI decreased significantly from 12 to 24 weeks in the high-dose DRI group (p<0.05) but not in the combination group (p=0.14).<br> Conclusions: Treatment with a DRI contributes to a decrease in the CBP and AI, and high-dose DRI therapy leads to a further decrease in the CBP and AI.<br>

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