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Combined vascular effects of HMG-CoA reductase inhibitor and angiotensin receptor blocker in non-diabetic patients undergoing peritoneal dialysis

Authors
 Seung Hyeok Han  ;  Ea Wha Kang  ;  Se-Jung Yoon  ;  Hyang Sook Yoon  ;  Hyun Chul Lee  ;  Tae Hyun Yoo  ;  Kyu Hun Choi  ;  Dae-Suk Han  ;  Shin-Wook Kang 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.26(11) : 3722-3728, 2011 
Journal Title
NEPHROLOGY DIALYSIS TRANSPLANTATION
ISSN
 0931-0509 
Issue Date
2011
MeSH
Angiotensin II Type 1 Receptor Blockers/therapeutic use* ; Brachial Artery/drug effects* ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Kidney Failure, Chronic/blood ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Peritoneal Dialysis/adverse effects* ; Prognosis ; Prospective Studies ; Tetrazoles/therapeutic use ; Valine/analogs & derivatives ; Valine/therapeutic use ; Valsartan ; Vascular Resistance/drug effects* ; Vascular Stiffness/drug effects* ; Vasodilation/drug effects*
Keywords
angiotensin receptor blocker ; arterial stiffness ; endothelial function ; peritoneal dialysis ; statin
Abstract
BACKGROUND: Statins and angiotensin receptor blockers (ARBs) are known to improve vascular dysfunction in patients with chronic kidney disease. However, these effects have been inconsistent in dialysis patients. Moreover, it is currently unknown whether adding statins to ARBs improves vascular dysfunction better than ARB monotherapy in these patients.

METHODS: We conducted a prospective open randomized trial to investigate the effects of statin add-on to ARB on vascular protection in 124 nondiabetic patients undergoing peritoneal dialysis (PD). Initially, all patients received 80 mg/day of valsartan for 6 months. Excluding 10 patients who dropped out during this period, patients were randomly assigned to continue ARB treatment alone (n = 57) or to receive 10 mg/day of rosuvastatin (n = 57) added to ARB for the next 6 months. To assess vascular function, endothelium-dependent vasodilation and arterial stiffness were determined by brachial artery flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV), respectively.

RESULTS: Compared to baseline values, ARB treatment for the first 6 months significantly improved FMD% (2.97 ± 2.64 to 3.57 ± 2.58 %, P < 0.001). In addition, there was a small but significant decrease in baPWV during this period (1691.5 ± 276.3 to 1635.0 ± 278.6 cm/s, P = 0.048). After randomization, add-on treatment further improved FMD% (3.57 ± 2.73 to 4.24 ± 2.77 %, P = 0.003), whereas ARB monotherapy did not (P = 0.02 for between-group difference). Further slight improvement in baPWV (1617.0 ± 280.9 to 1528.9 ± 266.8 cm/s, P = 0.021) was observed only in the combined treatment group (P = 0.28 for between-group difference).

CONCLUSIONS: Adding a statin to the ARB was of some help in improving vascular dysfunction more effectively than ARB monotherapy in nondiabetic PD patients. However, whether such limited improvements can lead to better clinical outcomes requires further investigation.
Files in This Item:
T201103746.pdf Download
DOI
10.1093/ndt/gfr108
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Hyun Chul(이현철)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94465
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