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Effects of Azilsartan Compared to Other Angiotensin Receptor Blockers on Left Ventricular Hypertrophy and the Sympathetic Nervous System in Hemodialysis Patients
Author(s) -
Kusuyama Takanori,
Ogata Hirohito,
Takeshita Hiroaki,
Kohno Hiroaki,
Shimodozono Shinichi,
Iida Hidetaka,
Tsukazaki Takashi
Publication year - 2014
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12168
Subject(s) - medicine , blood pressure , left ventricular hypertrophy , cardiology , ambulatory blood pressure , angiotensin receptor , angiotensin ii , endocrinology
Hypertension is a major risk factor for cardiovascular and cerebrovascular events, and most patients with hypertension are administered antihypertensive drugs. However, not all patients achieve normal blood pressure levels. The new angiotensin receptor blocker azilsartan ( T akeda P harmaceutical C ompany L imited, O saka, J apan) has been reported to have a strong hypotensive effect. Our study investigated the efficacy of azilsartan compared with other angiotensin receptor blockers. This study included 17 hypertensive patients on HD, who had been administered angiotensin receptor blockers, except for azilsartan, for more than 6 months before enrolling, and after enrollment, they were switched to azilsartan. Blood tests, Holter electrocardiogram, ambulatory blood pressure monitoring, and echocardiography were performed at baseline and at the 6‐month follow‐up. The blood pressure from baseline to 6 months had significantly decreased (24‐h systolic blood pressure from 150.9 ± 16.2 mm Hg to 131.3 ± 21.7 mm Hg, P = 0.008), awakening time systolic blood pressure from 152.1 ± 16.9 mm Hg to 131.7 ± 23.2 mm Hg, P = 0.01, sleep‐time systolic blood pressure from 148.1 ± 19.7 mm Hg to 130.0 ± 20.1 mm Hg, P = 0.005). There was a significant reduction in serum noradrenaline levels as well as left ventricular mass index after switching to azilsartan (from 550.1 ± 282.9 pg/mL, to 351.7 ± 152.3 pg/mL, P = 0.002; from 117.0 ± 26.4 g/m 2 to 111.3 ± 23.9 g/m 2 , P = 0.01, respectively). Azilsartan had a significantly stronger hypotensive effect than other angiotensin receptor blockers. Thus, the switch to azilsartan might improve prognosis of hemodialysis patients. We suggest that the strong anti‐hypertensive effect of azilsartan originated from a combination of primary angiotensin receptor blocker class‐effect and a stronger suppression of sympathetic nervous system.