Abstract
Objective: Arterial stiffness is linked to the progression of atherosclerosis, while activation of vitamin D receptor exerts favorable cardiovascular effects in patients with renal insufficiency. In this study we investigated the effects of oral treatment with paricalcitol, a potent vitamin D receptor activator on arterial stiffness and osteopontin, a marker of atheroscleroris, in hypertensive patients with chronic kidney disease (CKD) and secondary hyperparathyroidism. Design and method: We followed up 29 treated hypertensive patients (mean age 74.1 years, 19 men, office blood pressure = 132/85 mmHg) with CKD stages 3–5 [mean glomerular filtration rate (GFR) = 19.4 ml/min/1.73m2], who were on therapy with oral paricalcitol for 1 year. All patients at baseline underwent a complete physical examination, while venous blood samples were drawn for estimation of metabolic profile, levels of intact parathormone, phosphorus and calcium and osteopontin. Arterial stiffness was estimated based on carotid-femoral pulse wave velocity (PWV) measured with an automated device. Results: After 1 year of treatment with paracalcitol compared to baseline there was no statistical difference in levels of GFR (19.5 ± 4.8 ml/min/1.73m2 vs 18.0 ± 2.3 ml/min/1.73m2, p = 0.318) and calcium (9.11 ± 2.3 vs 8.98 ± 2.2 mg/dl, p = 0.344). Regarding the metabolic profile of patients, levels of glucose, lipids or uric acid did not differ, while the product of calcium x phosphorus exhibited no pathological values. Additionally, carotid-femoral PWV was reduced after 1 year treatment with oral paricalcitol from 11.8 ± 2.6 m/sec to 11.2 ± 2.4 m/sec (p < 0.05), while blood pressure values and osteopontin levels 1 year after therapy compared to baseline values had no statistical difference (p = NS). Conclusions: Treatment with oral paricalcitol in hypertensive subjects suffering from CKD stages 3–5 and secondary hyperparathyroidism is accompanied by amelioration of arterial stiffness as reflected by the reduction of carotid-femoral PWV. These findings suggest that paricalcitol exerts pleiotropic favorable effects on the vascular system, thus improving cardiovascular prognosis in high risk hypertensive patients.
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