Abstract 12182: Candesartan vs Lisinopril on Measures of Arterial Stiffness and Wave Reflections in Older, Hypertensive Adults

Abstract

Introduction: Higher arterial stiffness independently predicts risk of future cardiovascular events. Although angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARBs) reduce blood pressure, their impact on vascular function may vary. Hypothesis: We hypothesized differences in the impact of ACEi compared to ARBs on arterial stiffness, wave reflections and microvascular function in hypertension among older men and women. Methods: We measured vascular function at baseline and after 1 year in 176 (87 Candesartan, 89 Lisinopril therapy) hypertensive participants with mild cognitive impairment (age 65.9 +/-7.7 years, 57% female). Pulse-wave velocity (PWV), central pulse pressure (CPP) and central augmentation index (AIx) were measured using applanation tonometry and the reactive hyperemia index using digital pulse amplitude tonometry. Results: While Candesartan and Lisinopril lowered blood pressure equally, only Lisinopril therapy resulted in a lower PWV (-0.7 ± 0.4 m/s, p=0.03) and CPP (-7 ± 4 mmHg, p=0.01) after 1 year, while Candesartan produced no significant change. There was a significant interaction by sex whereby arterial stiffness was lowered only in women with Lisinopril. Candesartan lowered AIx more than Lisinopril (-4 ± 7% vs -1.5 ± 8%, p=0.05) in both sexes. After adjustment for sex and cardiovascular risk factors, Lisinopril remained a significant predictor of lower PWV and CPP after 1 year (all p<0.05). Conclusions: In a cohort of older hypertensive patients, despite equipotent anti-hypertensive effects, Lisinopril was more effective than Candesartan at lowering arterial stiffness in women. Candesartan was effective in lowering wave reflections compared to Lisinopril.