Flammer, A J; Hermann, F; Wiesli, P; Schwegler, B; Chenevard, R; Hurlimann, D; Sudano, I; Gay, S; Neidhart, M; Riesen, W; Ruschitzka, F; Lüscher, T F; Noll, G; Lehmann, R (2007). Effect of losartan, compared with atenolol, on endothelial function and oxidative stress in patients with type 2 diabetes and hypertension. Journal of Hypertension, 25(4):785-791.
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OBJECTIVE: It has been shown that angiotensin-converting enzyme inhibition or angiotensin receptor blockade may improve endothelial dysfunction, an early manifestation of atherosclerosis, in patients with diabetes. Whether this protective effect is mediated through blood pressure-lowering effects or other specific mechanisms such as a reduction in oxidative stress is not clear. We investigated the influence of losartan, compared with atenolol, on endothelial function and oxidative stress in patients with type 2 diabetes and hypertension.
METHODS: Thirteen patients were included in this randomized, double-blind, crossover study; they received losartan 50 mg twice daily for 4 weeks followed by atenolol 50 mg twice daily or vice versa. Concomitant medication with renin-angiotensin blocking agents or beta-blockers was withdrawn, whereas other medication remained unchanged. At baseline and after each treatment period, flow-mediated dilation of the brachial artery and oxidative stress were measured in serum samples.
RESULTS: Flow-mediated dilation was increased significantly after 4 weeks' treatment with losartan (3.4 +/- 0.44%) compared with atenolol (2.58 +/- 0.42%; P = 0.01). 8-Isoprostanes, a marker of oxidative stress, were significantly reduced in the losartan group compared with baseline (0.039 +/- 0.007 versus 0.067 +/- 0.006 ng/ml; P = 0.01), but did not differ from baseline with atenolol. Glucose, hemoglobin A1c, highly sensitive C-reactive protein, lipids and systolic blood pressure remained unaltered, whereas diastolic blood pressure tended to be lower in the atenolol group.
CONCLUSIONS: This study demonstrates that losartan significantly improved endothelial function in type 2 diabetes patients with hypertension compared with atenolol. This must be independent of the blood pressure-lowering effect of losartan and is probably caused by an antioxidative effect of the angiotensin receptor blocker.
|Item Type:||Journal Article, refereed, original work|
|Communities & Collections:||04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology|
|DDC:||610 Medicine & health|
|Uncontrolled Keywords:||Antihypertensive Agents/*therapeutic use;Atenolol/*therapeutic use;Blood Pressure/drug effects;Brachial Artery/drug effects/physiopathology;Cross-Over Studies;Diabetes Mellitus, Type 2/metabolism/*physiopathology;Dinoprost/analogs & derivatives/blood;Double-Blind Method;Endothelium, Vascular/*drug effects/metabolism/physiopathology;Female;Humans;Hypertension/*drug therapy/metabolism/*physiopathology;Insulin Resistance;Losartan/*therapeutic use;Male;Middle Aged;Oxidative Stress/*drug effects;Regional Blood Flow/drug effects;Research Design;Treatment Outcome;Vasodilation/drug effects|
|Deposited On:||13 Dec 2010 14:18|
|Last Modified:||28 Nov 2013 01:12|
|Publisher:||Lippincott Wiliams & Wilkins|
|Citations:||Web of Science®. Times Cited: 41|
Scopus®. Citation Count: 52
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