1. ¹Preventive Medical Center, Tohoku Rosai Hospital, Sendai, Japan
2. ²Division of Hypertension and Cardiology, Tohoku Rosai Hospital, Sendai, Japan

Correspondence: Dr. Masanori Munakata, Preventive Medical Center, Tohoku Rosai Hospital 3–21 Dainohara 4, Aobaku, Sendai 981-8563, Japan E-mail: munakata.@tohokuh.rofuku.go.jp

^*Supported in part by Grants-in-Aid from the Labor and Welfare Cooperation, the Miyagi Prefectural Kidney Association, and Japan Arteriosclerosis Prevention Fund.

Received 19 September 2003; Revised 23 December 2003; Accepted 9 June 2004.

Abstract

Background: The aim of this study was to compare the effects of long-term antihypertensive treatment on brachial-ankle pulse wave velocity (PWV), a marker of systemic arterial stiffness, between angiotensin II receptor blocker valsartan and long-acting calcium channel blocker nifedipine coat-core.

Methods: Forty-one patients (54 3 years of age, 20 men and 21 women) with essential hypertension (155 3/95 3 mm Hg) were randomly allocated to the treatment with valsartan (80 mg once daily) or nifedipine coat-core (20 mg once daily). Brachial-ankle PWV and 24-h ambulatory blood pressures (BP) were measured before and 3 months after treatment.

Results: Baseline data did not differ between the valsartan and nifedipine groups. The PWV also was similar between the groups (1669 65 v 1622 64 cm/sec). Three months of treatment similarly reduced resting systolic and diastolic BP (nifedipine, -18.4 4.2/-11.9 2.7 mm Hg; valsartan, - 17.4 3.3/-9.8 2.1 mm Hg, all P < .001). The PWV was significantly reduced compared with baseline values in the valsartan group (-195 42 cm/sec, P < 0.001) but not in the nifedipine group (-69 40 cm/sec, NS). The 24-h mean heart rate increased in the nifedipine group but remained unchanged in the valsartan group, although BP were similarly lowered for 24 h. A tachycardic response was associated with an increase or lesser reduction in PWV in a group treated with nifedipine (r = 0.584, P < .01).

Conclusions: These data suggest that long-term treatment with valsartan could reduce arterial stiffness better than nifedipine-coat core. The favorable vascular effect of valsartan was due in part to its nonhypotensive effect. The expected decrease in arterial stiffness may be offset by reflex sympathetic activation in some patients treated with nifedipine.