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Aranda P , Cermeño L, Briceño EM, Herrador A, Perea L, Martinez MD, Hernandez D.

Aliskiren, but not Lisinopril, reduces Renal Vascular Resistivity in hypertensive patients with Metabolic Syndrome and Microalbuminuria. Aranda P , Cermeño L, Briceño EM, Herrador A, Perea L, Martinez MD, Hernandez D.

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Aranda P , Cermeño L, Briceño EM, Herrador A, Perea L, Martinez MD, Hernandez D.

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  1. Aliskiren, but not Lisinopril, reduces Renal Vascular Resistivity in hypertensive patients with Metabolic Syndrome and Microalbuminuria. Aranda P, Cermeño L, Briceño EM, Herrador A, Perea L, Martinez MD, Hernandez D. Hypertensión and Vascular Risk Unit. Carlos Haya University Regional Hospital. Málaga. Spain

  2. RATIONALE • Hypertensive patients with MS are highly prone to develop Nefroangiosclerosis. • In this situation, intrarenal RAS activation seems to play a relevant pathogenetic role. • Consistently, RAS blocking drugs through a reduction in renal vascular resistance and increase of the RPF, migth have a long-term renoprotective effects against the development of nephrosclerosis in these patients. • At this point, not all RAS Blockers have the same performance.

  3. Effects of different RAS Blockers on indirect measurements of Renal Plasma Flow. <0,01 N=19 Aliskiren - Aliskiren shows a persistent, dose-dependent effect, on RPF, expressed as an increase in natriuresis. Fisher ,Hollenberg et al. Circulation 2008;117:3199 Hollenberg et al Hypertension 1995;26:602 (Modified)

  4. OBJECTIVE To compare long-term effects on Renal Resistive Index (RRI) of a therapeutic regimen based on Aliskiren 300 mg versus Lisinopril 20 mg OD in hypertensive patients with MS (At least 3 components according to NCEP-ATP III criteria) and Microalbuminuria (UAER 30-300 mg/24 h).

  5. PATIENTS & METHODOLOGY. • After adjustement for age, sex and BMI,78 hypertensive patients with MS and microalbuminuria were randomly assigned, in an open design, either to a therapeutic regimen based on Aliskiren 300 mg (n-40) or Lisinopril 20 mg OD (n-38) plus an average of 3 antihypertensive drugs, especially Diuretics (92%) and CCBs (83%),and followed by 12 months. • At inclusión and 12 months, BMI, WC, office BP (mean 3 readings) and metabolic and renal analytical profile, including 24 h microalbuminuria (mean of 2consecutive days), were determined. • Also at the same times, all patients underwent a renal bilateral echo-doppler at the level of the upper, middle and lower lobar arteries, by the same examiner, to measure Renal Resistive Index, according to standard equation: (1-(End Diastolic velocity : Peak Systolic velocity) x 100). • All pts gave their informed consent.

  6. ASSOCIATED TREATMENTS (%) Average antihypertensive drugs: 3

  7. Results - 1.ANTHROPOMETRIC FEATURES

  8. Results-2.BIOCHEMICAL PARAMETERS. K+(mmol/L) 4,16±0.15 (.007) 4,23±0.17 4,24±0,14 (0.001)4,38±0,18

  9. Results- 3.CHANGES IN RENAL FUNCTION AND RRI. In a multivariate analysis, after adjust for confounders, the risk for RRI > 0.70 was: OR: 1,55(0,63 – 2,43) for Lisinopril vs Aliskiren (*) Test Mann-Withney

  10. Conclusions • In hypertensive patients with MS and Microalbuminuria, Aliskiren was able to reduce Renal Resistive Index and Microalbuminuria in a greater extent than did Lisinopril. • In a long-term, this effect could provide nephroprotection against developing nephosclerosis in these type of patients. • Aliskiren migth be a good choice for treating this kind of patients.

  11. There were no conflicts of interest.Many thanks for your attention.

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