Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Guimarães Filho, Gilberto Campos; Araújo, Reila Campos Guimarães de; Cabral, Karynne Borges; Paula, Cácia Régia de

doi:10.36660/ijcs.20220162

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International Journal of Cardiovascular Sciences

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ORIGINAL ARTICLE • Int J Cardiovasc Sci 36 • 2023 • https://doi.org/10.36660/ijcs.20220162 copy

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Arterial stiffness and hypertension are strong predictors of cardiovascular disease and mortality. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line antihypertensive agents in reducing blood pressure and arterial stiffness.

Objective

The objective of this study was to compare the effects of ACEI and ARB in reducing arterial stiffness and preventing target organ damage in patients with hypertension.

Methods

This observational study included 654 participants who attend routine consultations at an outpatient hypertension clinic in 2 university hospitals. Patients were interviewed, and they underwent central and peripheral blood pressure measurements. Doppler echocardiography, carotid ultrasound, biochemical tests, and anthropometric parameters were carried out. Shapiro-Wilk, chi-square, and Fisher’s exact test were used. A significance level of 5% was adopted.

Results

A total of 659 participants were evaluated in the study (398 from the ARB group and 256 from the ACEI group). Age, body mass index (BMI), central and peripheral blood pressure measurements, pulse wave velocity (PWV), left ventricular mass index, and carotid intima-media thickness did not show differences between the groups (p > 0.05). After linear regression analysis, the ACEI group had lower values of total vascular resistance (TVR) (p = 0.003) and augmentation pressure (p = 0.008), when compared to the ARB group.

Conclusion

This study showed that the ACEI group had a greater reduction in augmentation pressure and PWV. There were no differences between the groups regarding the improvement of outcomes related to central arterial pressure, PWV, and cardiac and vascular target organ damage.

Vascular Stiffness; Hypertension; Pulse Wave Analysis; Angiotensin-Converting Enzyme Inhibitors; Angiotensin Receptor Antagonists

Variables/groups		ARB		ACEI		p

		n	%	n	%
Sex	Female	215	66.36%	109	33.64%	0.007 ¹
Sex	Male	182	55.66%	145	44.34%	0.007 ¹
BMI (kg/m ² )	Underweight	1	33.33%	2	66.67%	0.202 ²
	Normal weight	36	57.14%	27	42.86%
	Overweight	87	59.59%	59	40.41%
	Obesity, class 1	62	72.09%	24	27.91%
	Obesity, class 2	27	71.05%	11	28.95%
	Obesity, class 3	8	66.67%	4	33.33%
Age (years)		397	57.69%	254	57.68%	0.849 ³
Variables/groups		ARB		ACEI		p
Variables/groups		n	%	n	%	p
Sex	Female	214	66.25%	109	33.75%	0.006 ¹
Sex	Male	182	55.66%	145	44.34%	0.006 ¹
BMI (kg/m ² )	Underweight	1	33.33%	2	66.67%	0.202 ²
	Normal weight	36	57.14%	27	42.86%
	Overweight	87	59.59%	59	40.41%
	Obesity, class 1	62	72.09%	24	27.91%
	Obesity, class 2	27	71.05%	11	28.95%
	Obesity, class 3	8	66.67%	4	33.33%
Age (years)	Mean and standard deviation	57.72	14.00	57.67	15.75	0.970 ³

Variables/groups		ARB		ACEI		p

		n	%	n	%
Obesity (30 kg/m2)	Yes	97	71.32%	39	28.68%	0.018
	No	123	58.29%	88	41.71%
	Not found	1	100.00%	0	0.00%
Smoking	1	8	72.73%	3	27.27%	0.166
	2	144	67.29%	70	32.71%
	3	34	57.63%	25	42.37%
	4	34	53.97%	29	46.03%
Sedentary behavior	Yes	122	74.85%	41	25.15%	0.018
	No	142	76.34%	44	23.66%
	Not found	68	61.82%	42	38.18%
Diabetes mellitus	Yes	77	75.49%	25	24.51%	1.000
	No	310	75.43%	101	24.57%
	Not found	4	80.00%	1	20.00%
Dyslipidemia	Yes	241	71.94%	94	28.06%	0.026
	No	148	81.77%	33	18.23%
	Not found	2	100.00%	0	0.00%
Beta blocker	Nebilet	20	66.67%	10	33.33%	0.713
	Neblock	17	65.38%	9	34.62%
	Others	360	60.50%	235	39.50%
Calcium channel blocker	Diovan amlo	11	100.00%	0	0.00%	<0.001
	Exforge	12	100.00%	0	0.00%
	Manivasc	8	42.11%	11	57.89%
	Others	358	59.87%	240	40.13%
	Zanidip	8	72.73%	3	27.27%
Diuretic	Benicar HCT	11	100.00%	0	0.00%	<0.001
	Coversyl plus	0	0.00%	24	100.00%
	Diovan HCT	12	100.00%	0	0.00%
	Exforge	11	100.00%	0	0.00%
	Others	363	61.21%	230	38.79%
Number of antihypertensive drugs	0	0	0.00%	1	100.00%	0.226
	1	115	51.57%	108	48.43%
	2	78	41.94%	108	58.06%
	3	20	42.55%	27	57.45%
	4	7	41.18%	10	58.82%
	5	1	100.00%	0	0.00%
24-hour ABPM	Yes	48	53.33%	42	46.67%	0.125
	No	323	62.24%	196	37.76%
	Not found	6	85.71%	1	14.29%
Carotid ultrasound	Yes	136	60.71%	88	39.29%	0.383
	No	239	61.28%	151	38.72%
	Not found	4	100.00%	0	0.00%
Doppler echocardiogram	Yes	207	57.66%	152	42.34%	0.061
	No	168	66.14%	86	33.86%
	Not found	4	80.00%	1	20.00%
Variables/groups		ARB		ACEI		p
Variables/groups		n	%	n	%	p
Obesity (30 kg/m2)	Yes	186	68.09%	84	31.11%	<0.001 ¹
Obesity (30 kg/m2)	No	210	55.26%	84	31.11%	<0.001 ¹
Smoking	1	8	72.73%	3	27.27%	0.166 ²
	2	144	67.29%	70	32.71%
	3	34	57.63%	25	42.37%
	4	34	53.97%	29	46.03%
Sedentary behavior	Yes	122	74.85%	41	25.15%	0.018 ¹
	No	142	76.34%	44	23.66%
	Not found	68	61.82%	42	38.18%
Diabetes mellitus	Yes	77	75.49%	25	24.51%	1.000 ²
	No	309	75.37%	101	24.63%
	Not found	4	80.00%	1	20.00%
Dyslipidemia	Yes	240	71.86%	94	28.14%	0.024 ²
	No	148	81.77%	33	18.23%
	Not found	2	100.00%	0	0.00%
Beta blocker	1	117	73.58%	42	26.42%	0.713 ¹
Beta blocker	2	274	56.38%	212	43.62%	0.713 ¹
Calcium channel blocker	1	128	63.05%	75	36.95%	0.403 ¹
Calcium channel blocker	2	264	59.59%	179	40.41%	0.403 ¹
Diuretic	1	178	64.73%	97	35.27%	0.070 ¹
Diuretic	2	214	57.68%	157	42.32%	0.070 ¹
Number of antihypertensive drugs	0	0	0.00%	1	100.00%	0.226 ²
	1	115	51.57%	108	48.43%
	2	78	41.94%	108	58.06%
	3	20	42.55%	27	57.45%
	4	7	41.18%	10	58.82%
	5	1	100.00%	0	0.00%
24-hour ABPM	Yes	48	53.33%	42	46.67%	0.125 ²
	No	322	62.28%	196	37.72%
	Not found	6	85.71%	1	14.29%
Carotid ultrasound	Yes	136	60.71%	88	39.29%	0.383 ²
	No	238	61.34%	150	38.66%
	Not found	4	100.00%	0	0.00%
Doppler echocardiogram	Yes	207	57.66%	152	42.34%	0.057 ²
	No	167	66.27%	85	33.73%
	Not found	4	80.00%	1	20.00%

Variable	Groups	n	Mean	SE	Q1	Q2	Q3	p
PSBP	ARB	395	133.05	0.96	120.00	130.00	143.00	0.209
PSBP	ACEI	254	130.98	1.22	118.00	129.00	141.00	0.209
PDBP	ARB	395	82.93	0.62	74.50	83.00	91.00	0.062
PDBP	ACEI	254	80.34	0.87	71.00	81.00	90.00	0.062
PPP	ARB	395	50.13	0.71	40.00	48.00	58.50	0.656
PPP	ACEI	254	49.19	0.78	41.00	47.50	55.00	0.656
CSBP	ARB	395	122.17	0.87	110.00	121.00	131.00	0.187
CSBP	ACEI	254	120.07	1.07	108.00	119.50	129.00	0.187
CDBP	ARB	395	84.32	0.62	75.00	85.00	92.00	0.117
CDBP	ACEI	254	82.93	0.91	73.00	83.00	91.00	0.117
CPP	ARB	395	37.87	0.58	30.00	36.00	45.00	0.884
CPP	ACEI	254	37.16	0.60	30.00	36.00	43.00	0.884
TVR	ARB	395	1.32	0.04	1.10	1.20	1.40	0.032
TVR	ACEI	254	1.27	0.04	1.08	1.20	1.32	0.032
AP	ARB	395	10.71	0.52	4.00	7.00	14.50	0.382
AP	ACEI	252	9.22	0.45	4.00	7.00	12.80	0.382
Aix	ARB	395	24.37	0.69	14.00	22.00	33.00	0.093
Aix	ACEI	254	22.55	0.86	12.00	20.00	32.30	0.093
PWV	ARB	395	8.70	0.11	7.20	8.30	9.90	0.487
PWV	ACEI	254	8.65	0.14	7.00	8.10	9.90	0.487
Variable	Groups	Median		p25		p75		p ¹
PSBP	ARB	130.00		120.00		143.00		0.209
PSBP	ACEI	129.00		118.00		141.00		0.209
PDBP	ARB	83.00		74.50		91.00		0.062
PDBP	ACEI	81.00		71.00		90.00		0.062
PPP	ARB	48.00		40.00		58.50		0.656
PPP	ACEI	47.50		41.00		55.00		0.656
CSBP	ARB	121.00		110.00		131.00		0.187
CSBP	ACEI	119.50		108.00		129.00		0.187
CDBP	ARB	85.00		75.00		92.00		0.117
CDBP	ACEI	83.00		73.00		91.00		0.117
CPP	ARB	36.00		30.00		45.00		0.884
CPP	ACEI	36.00		30.00		43.00		0.884
TVR	ARB	1.20		1.10		1.40		0.032
TVR	ACEI	1.20		1.08		1.32		0.032
AP	ARB	7.00		4.00		14.50		0.382
AP	ACEI	7.00		4.00		12.80		0.382
Aix	ARB	22.00		14.00		33.00		0.093
Aix	ACEI	20.00		12.00		32.30		0.093
PWV	ARB	8.30		7.20		9.90		0.487
PWV	ACEI	8.10		7.00		9.90		0.487

Variables	Coefficient	95% CI	p
PSBP ¹	−0.02	−0.05 to 0.01	0.138
PDBP ²	−0.03	−0.07 to 0.00	0.072
PPP ³	−0.01	−0.07 to 0.05	0.816
CSBP ⁴	−0.02	−0.05 to 0.01	0.200
CDBP ⁵	−0.03	−0.07 to 0.00	0.078
CPP ⁶	0.01	−0.06 to 0.08	0.765
TVR ⁷	−0.07	−0.12 to −0.02	0.003
AP ⁸	−0.26	−0.45 to 0.07	0.008
Aix ⁹	−0.25	−0.47 to −0.04	0.022
PWV ¹⁰	−0.01	−0.03 to 0.01	0.381

Variables	Odds ratio	95% CI	p
Carotid ultrasound 1	1.27	0.71 to 2.27	0.411
Doppler echocardiogram 2	0.96	0.55 to 1.68	0.896

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