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(Hypertension. 2008;51:1617.)
© 2008 American Heart Association, Inc.

Original Articles

Valsartan Improves Arterial Stiffness in Type 2 Diabetes Independently of Blood Pressure Lowering

Janaka Karalliedde; Andrew Smith; Lorenita DeAngelis; Vincenzo Mirenda; Albert Kandra; Jaco Botha; Philippe Ferber; Giancarlo Viberti

From the Cardiovascular Division (J.K., A.S., L.D., V.M., G.V.), King’s College London School of Medicine, United Kingdom; and Novartis Pharma AG (A.K., J.B., P.F.), Basel, Switzerland.

Correspondence to Dr J. Karalliedde, Unit for Metabolic Medicine, Cardiovascular Division, King’s College London School of Medicine, 5th Fl Southwark Wing, Guy’s Hospital, St Thomas St, London SE1 9RT, UK. E-mail j.karalliedde{at}kcl.ac.uk

Increased arterial stiffness, as estimated from aortic pulse wave velocity (Ao-PWV), and albuminuria are independent predictors for cardiovascular disease in type 2 diabetes mellitus (T2DM). Whether angiotensin receptor blockers (ARBs), drugs with cardio-renal protective effects, improve Ao-PWV to a greater extent than other equipotent antihypertensive medications remains unclear. After a 4-week washout phase, we compared the effects of valsartan (n=66), an ARB, with that of amlodipine (n=65), a calcium channel blocker on Ao-PWV in 131 T2DM patients with pulse pressure (PP) 60 mm Hg and raised albumin excretion rate (AER) in a 24-week randomized, double-blind, parallel group study. Hydrochlorothiazide (HCTZ) 25 mg/d was added to valsartan 160 mg and amlodipine 5 mg/od uptitrated to 10 mg/od after 4 weeks to ensure equivalent BP control. After 24 weeks brachial and central aortic PP had fallen to a similar extent with attained mean (SD) brachial and central PP of 61.6 (13.6) and 47.3 (14.1) mm Hg in the valsartan/HCTZ group and 61.5 (12.2) and 47.3 (9.9) mm Hg in the amlodipine group, respectively. Ao-PWV showed a significantly greater reduction, mean (95% CI), –0.9 m/s (–1.4 to –0.3) for valsartan/HCTZ compared to amlodipine (P=0.002). AER fell significantly only with Val/HCTZ from 30.8(20.4, 46.5) to 18.2(12.5, 26.3) mcg/min, (P=0.01) with between treatment difference in favor of Val/HCTZ of –15.3mcg/min (P<0.001). Changes in AER and Ao-PWV were not correlated. Valsartan/HCTZ improves arterial stiffness and AER to a significantly greater extent than amlodipine despite similar central and brachial BP control. These 2 effects, which appear independent of each other, may explain the specific cardio-renal protective properties of ARBs.

Key Words: type 2 diabetes • hypertension • arterial stiffness • albuminuria • angiotensin receptor blockers

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