Effect of Aliskiren on Circulating Endothelial Progenitor Cells and Vascular Function in Patients With Type 2 Diabetes and Essential Hypertension

• Published in: American journal of hypertension Vol. 28; no. 1; pp. 22 - 29
• Main Authors: Raptis, Athanasios E., Markakis, Konstantinos P., Mazioti, Maria C., Ikonomidis, Ignantios, Maratou, Eirini P., Vlahakos, Dimitrios V., Kotsifaki, Eleni E., Voumvourakis, Asterios N., Tsirogianni, Alexandra G., Lambadiari, Vaia A., Lekakis, John P., Raptis, Sotirios A., Dimitriadis, George D.
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-01-2015
• Subjects: Aged; Amides - therapeutic use; Antihypertensive Agents - therapeutic use; Arterial Pressure - drug effects; Biomarkers - blood; Cells, Cultured; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Diuretics - therapeutic use; Drug Substitution; Endothelial Progenitor Cells - drug effects; Endothelial Progenitor Cells - metabolism; Endothelium, Vascular - drug effects; Endothelium, Vascular - metabolism; Endothelium, Vascular - physiopathology; Female; Fumarates - therapeutic use; Hemodynamics - drug effects; Humans; Hydrochlorothiazide - therapeutic use; Hypertension - blood; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - physiopathology; Male; Middle Aged; Pilot Projects; Time Factors; Treatment Outcome; Vascular Stiffness - drug effects; Vasodilation - drug effects; Ventricular Function, Left - drug effects; arterial stiffness; blood pressure; vascular function; aliskiren; endothelial progenitor cells; diabetes mellitus; hypertension
• DOI: 10.1093/ajh/hpu119
• EISSN: 1941-7225
• ISSN: 0895-7061

BACKGROUND
The aim of this study was to investigate the effects of aliskiren on vascular function and endothelial progenitor cells (EPCs) in patients with type 2 diabetes and essential hypertension.
METHODS
The study enrolled type 2 diabetic patients aged >50 years under stable glycemic control and first diagnosed mild essential hypertension. In phase A (n = 20), patients received aliskiren 150–300mg daily for 3 months. In phase B (n = 12), hydrochlorothiazide (HCTZ) 12.5–25mg daily substituted for aliskiren for 3 more months. At baseline and at the end of each phase, we assessed (i) brachial blood pressure (BBP); (ii) central aortic systolic pressure (CSP), aortic augmentation index (Aix), and pulse wave velocity (PWV) as markers of arterial stiffness; (iii) brachial artery flow-mediated dilatation (FMD) as a marker of endothelial function; (iv) left ventricular (LV) twisting and untwisting as markers of LV function and (v) EPC numbers in culture of peripheral blood mononuclear cells.
RESULTS
Aliskiren similarly reduced BBP and CSP, increased FMD (P < 0.001) and EPC numbers (P < 0.001), decreased PWV and Aix (P < 0.05), and improved LV twisting and untwisting (P < 0.05). Although substitution of HCTZ sustained BBP at similar levels, CSP and echocardiographic indices nearly returned at baseline levels, and the improvement of FMD, PWV, Aix, and EPC numbers was abolished.
CONCLUSIONS
Aliskiren
had a favorable effect on endothelial function and EPCs, reduced arterial stiffness, and improved LV twisting and untwisting. These effects were independent of BBP lowering, as they were not observed after the achievement of similar values of BBP with HCTZ.