Why the study?
Antihypertensive treatment effects on the RAAS may influence inflammatory and anti-inflammatory pathways, prompting evaluation of how newly initiated antihypertensive drugs affect Ang II and Ang (1-7).
Do different first-line antihypertensive drugs (perindopril, olmesartan, amlodipine, hydrochlorothiazide) differentially affect RAAS peptide concentrations in newly diagnosed hypertensive patients?
Do different first-line antihypertensive drugs (perindopril, olmesartan, amlodipine, hydrochlorothiazide) differentially affect RAAS peptide concentrations in newly diagnosed hypertensive patients?
Perindopril and olmesartan appear to shift RAAS peptides toward an anti-inflammatory profile by increasing Ang (1-7) compared to amlodipine and hydrochlorothiazide in newly diagnosed hypertensive patients.
Distinct RAAS shifts with first-line agents merit caution in newly diagnosed hypertension; leaves open whether they favor anti-inflammatory effects clinically.
(1) Background: Recently, influences of antihypertensive treatment on the renin–angiotensin–aldosterone system (RAAS) has gained attention, regarding a possible influence on inflammatory and anti-inflammatory pathways. We aimed to study the effects of newly initiated antihypertensive drugs on angiotensin (Ang) II and Ang (1–7) as representers of two counter-regulatory axes. (2) Methods: In this randomized, open-label trial investigating RAAS peptides after the initiation of perindopril, olmesartan, amlodipine, or hydrochlorothiazide, Ang II and Ang (1–7) equilibrium concentrations were measured at 8 a.m. and 12 a.m. at baseline and after four weeks of treatment. Eighty patients were randomized (1:1:1:1 fashion). (3) Results: Between the four substances, we found significant differences regarding the concentrations of Ang II (p < 0.0005 for 8 a.m., 12 a.m.) and Ang (1–7) (p = 0.019 for 8 a.m., <0.0005 for 12 a.m.) four weeks after treatment start. Ang II was decreased by perindopril (p = 0.002), and increased by olmesartan (p < 0.0005), amlodipine (p = 0.012), and hydrochlorothiazide (p = 0.001). Ang (1–7) was increased by perindopril and olmesartan (p = 0.008/0.002), but not measurably altered by amlodipine and hydrochlorothiazide (p = 0.317/ 0.109). (4) Conclusion: The initiation of all first line antihypertensive treatments causes early and distinct alterations of equilibrium angiotensin levels. Given the additional AT1R blocking action of olmesartan, RAAS peptides shift upon initiation of perindopril and olmesartan appear to work in favor of the anti-inflammatory axis compared to amlodipine and hydrochlorothiazide.
No takes yet. Share an insight, caveat, or question.
Vischer et al. (2021) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: