Peters, Christian Daugaard5; Kjaergaard, Krista D6; Jensen, Jens D6; Christensen, Kent L7; Strandhave, Charlotte1; Tietze, Ida N8; Novosel, Marija K9; Bibby, Bo M10; Jensen, Lars T11; Sloth, Erik12; Jespersen, Bente6
1 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN2 The Faculty of Medicine, Aalborg University, VBN3 Klinik Medicin, The Faculty of Medicine, Aalborg University, VBN4 Nyremedicin (Nefrologi), The Faculty of Medicine, Aalborg University, VBN5 Institut for Klinisk Medicin - Nyremedicinsk afdeling C6 Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.7 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.8 Department of Medicine, Viborg Regional Hospital, Viborg, Denmark.9 Department of Medicine, Fredericia Hospital, Fredericia, Denmark.10 Department of Biostatistics, Aarhus University, Aarhus, Denmark.11 Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark.12 Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Agents blocking the renin-angiotensin-aldosterone system are frequently used in patients with end-stage renal disease, but whether they exert beneficial cardiovascular effects is unclear. Here the long-term effects of the angiotensin II receptor blocker, irbesartan, were studied in hemodialysis patients in a double-blind randomized placebo-controlled 1-year intervention trial using a predefined systolic blood pressure target of 140 mm Hg (SAFIR study). Each group of 41 patients did not differ in terms of age, blood pressure, comorbidity, antihypertensive treatment, dialysis parameters, and residual renal function. Brachial blood pressure decreased significantly in both groups, but there was no significant difference between placebo and irbesartan. Use of additional antihypertensive medication, ultrafiltration volume, and dialysis dosage were not different. Intermediate cardiovascular end points such as central aortic blood pressure, carotid-femoral pulse wave velocity, left ventricular mass index, N-terminal brain natriuretic prohormone, heart rate variability, and plasma catecholamines were not significantly affected by irbesartan treatment. Changes in systolic blood pressure during the study period significantly correlated with changes in both left ventricular mass and arterial stiffness. Thus, significant effects of irbesartan on intermediate cardiovascular end points beyond blood pressure reduction were absent in hemodialysis patients.Kidney International advance online publication, 26 March 2014; doi:10.1038/ki.2014.69.
Kidney International, 2014, Vol 86, Issue 3, p. 625-637