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Pulse pressure, arterial stiffening, and the efficacy of renin–angiotensin system inhibitor combinations

Journal of Human Hypertension volume 32, pages 165–166 (2018)Cite this article

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A recent editorial by Shahid and colleagues [1] discusses the role of renin–angiotensin system (RAS) blockade in atrial fibrillation (AF) and summarizes evidence that substantiates the need to explore the potential of these agents for AF prevention. Pulse pressure (PP) is a surrogate of arterial stiffening which increases cardiac afterload leading to AF [2]. The exact mechanism is unclear; however, a link between widening of PP and incident AF is documented in the literature [3]. Using recently published Systolic Blood Pressure Intervention Trial (SPRINT) [4] data, our objective was to determine the association between RAS combination use and PP reduction.

Our data provides preliminary evidence that combination of RAS with diuretics or CCB have superior efficacy than antihypertensive monotherapies as pharmacological intervention for reducing PP (i.e., de-stiffening). The relation between PP reduction and AF is not documented in the current literature, however, the link between use of RAS combinations and reduction of incident AF has been demonstrated in the studies summarized by Shahid and colleagues [1]. Together, the data from our study and the evidence cited by Shahid and colleagues indicate that the use of RAS combinations can achieve positive short-term outcome of reduced PP which might be contributing towards long-term benefit of reduced AF. In summary, these findings further emphasize the need of clinical studies investigating the association between PP and AF, and the role and efficacy of RAS combinations for the prevention of AF.

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References

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Authors and Affiliations

  1. Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA

    Kalyani B. Sonawane & Ashish A. Deshmukh

  2. Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA

    Mark S. Segal

  3. Division of Nephrology, Hypertension and Renal Transplantation, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA

    Mark S. Segal

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  1. Kalyani B. Sonawane
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  2. Ashish A. Deshmukh
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  3. Mark S. Segal
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Correspondence to Kalyani B. Sonawane.

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Sonawane, K.B., Deshmukh, A.A. & Segal, M.S. Pulse pressure, arterial stiffening, and the efficacy of renin–angiotensin system inhibitor combinations. J Hum Hypertens 32, 165–166 (2018). https://doi.org/10.1038/s41371-017-0014-1

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