Effect of amlodipine, quinapril, and losartan on pulse wave velocity and plasma collagen markers in patients with mild-to-moderate arterial hypertension

Background: Carotid-femoral pulse wave velocity (PWV) is a prognostic factor in arterial hypertension. Modification of PWV, apart from blood pressure (BP) lowering seems to be important in the evaluation of antihypertensive drugs. One of the underlying causes arterial stiffening is arterial wall fibrosis. Plasma collagen I metabolites: carboxy (PICP) and amino (PINP) propeptides are considered as a valuable approach in the assessment of arterial fibrosis. The purpose of the present study was to compare changes in BP, PWV, plasma aldosterone, and collagen metabolites after treatment with amlodipine, quinapril, and losartan. Methods: One hundred eighteen patients with mild-to-moderate essential arterial hypertension were randomized to treatment with 10 mg/d of amlodipine (group 1), 20 mg/d of quinapril (group 2), or 2 x 50 mg/d of losartan (group 3). At baseline, and after 3 and 6 months analysis of variance was performed to compare changes in BP, PWV, aldosterone, PICP, and PINP among subjects with adequate BP control on monotherapy (group 1, n = 38, group 2, n = 37, group 3, n = 24). Results: Blood pressure decreased equally in all groups. Among patients with comparable BP values on monotherapy, only quinapril-treated patients showed a significant decrease in PWV, aldosterone, and PICP as compared with baseline values. Multiple regression analysis showed that PWV was significantly affected by: age (beta = 0.36; P = .021), systolic BP (beta = 0.45; P =.014), and PICP (beta = 0.27; P =.038). Conclusions: In hypertensive subjects PWV depends on age, systolic BP, and collagen synthesis. Of the three drugs with comparable BP-lowering efficacy only quinapril significantly decreases PWV, plasma aldosterone, and PICP. Am J Hypertens 2003;16:439-444 (C) 2003 American Journal of Hypertension, Ltd.