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CLINICAL RESEARCH: HYPERTENSION

Olmesartan, But Not Amlodipine, Improves Endothelium-Dependent Coronary Dilation in Hypertensive Patients

Masanao Naya, MD^_*, Takahiro Tsukamoto, MD^_*,, Koichi Morita, MD, Chietsugu Katoh, MD, Tomoo Furumoto, MD^_*, Satoshi Fujii, MD^_*, Nagara Tamaki, MD and Hiroyuki Tsutsui, MD^_*,_*

^_* Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Department of Health Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Department of Cardiovascular Medicine, Date Red Cross Hospital, Date, Japan.

Manuscript received April 10, 2007; revised manuscript received May 24, 2007, accepted June 11, 2007.

^_* Reprint requests and correspondence: Dr. Hiroyuki Tsutsui, Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan. (Email: htsutsui{at}med.hokudai.ac.jp).

Objectives: We aimed to compare the effects of the angiotensin II receptor blocker (ARB) olmesartan versus the calcium channel blocker (CCB) amlodipine on coronary endothelial dysfunction in patients with hypertension.

Background: Angiotensin II receptor blockers are thought to have greater beneficial effects than CCBs on coronary vasomotion by directly blocking action of angiotensin II.

Methods: Twenty-six patients with untreated essential hypertension were prospectively assigned to treatment with either olmesartan (27.7 ± 12.4 mg/day, n = 13) or amlodipine (5.6 ± 1.5 mg/day, n = 13) for 12 weeks. Changes of corrected myocardial blood flow (MBF) and coronary vascular resistance (CVR) from rest to cold pressor were measured by using ¹⁵O-water and positron emission tomography before and after treatment. Blood biomarkers including lipids, glucose, insulin, high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and superoxide dismutase (SOD) were also measured.

Results: Olmesartan and amlodipine reduced blood pressure (BP) to the same extent (–28.7 ± 16.2 mm Hg vs. –26.7 ± 10.8 mm Hg). In the olmesartan group, MBF tended to be greater (–0.15 ± 0.19 ml/g/min vs. 0.03 ± 0.17 ml/g/min, p = 0.09 by 2-way analysis of variance), and CVR was significantly decreased (7.9 ± 23.5 mm Hg/[ml/g/min] vs. –16.6 ± 18.0 mm Hg/[ml/g/min], p < 0.05) after treatment, whereas these parameters did not change in the amlodipine group (MBF: –0.15 ± 0.12 ml/g/min vs. –0.12 ± 0.20 ml/g/min; CVR: 6.5 ± 18.2 mm Hg/[ml/g/min] vs. 4.8 ± 23.4 mm Hg/[ml/g/min]). Serum SOD activity tended to increase (4.74 ± 4.77 U/ml vs. 5.57 ± 4.74 U/ml, p = 0.07 by 2-way analysis of variance) only in the olmesartan group.

Conclusions: Olmesartan, but not amlodipine, improved endothelium-dependent coronary dilation in hypertensive patients independent of BP reduction. These beneficial effects on coronary vasomotion might be via an antioxidant property of ARBs.

Abbreviations and Acronyms   ARB = angiotensin II receptor blocker   BP = blood pressure   CCB = calcium channel blocker   CPT = cold pressor test   CVR = coronary vascular resistance   HOMA-IR = homeostasis model assessment for insulin resistance   IL = interleukin   MBF = myocardial blood flow   15O-water = oxygen-15–labeled water   PET = positron emission tomography   RPP = rate pressure product   SOD = superoxide dismutase   TNF = tumor necrosis factor

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