Antihypertensive Therapy Considering the Prevention of Vascular Aging

Toshihiko Ishimitsu

doi:10.5646/jksh.2011.17.3.85

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Ishimitsu: Antihypertensive Therapy Considering the Prevention of Vascular Aging

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J Korean Soc Hypertens 2011;17(3):85-94.

Published online: 10 September 2011

DOI: https://doi.org/10.5646/jksh.2011.17.3.85

Antihypertensive Therapy Considering the Prevention of Vascular Aging

Toshihiko Ishimitsu, MD

Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan

Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan Tel: +81-282-87-2149, Fax: +81-282-86-6186

Received 24 August 201110 September 2011 Accepted 14 September 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Considering that an aging population is increasing due to a low birth rate in most developed nations, the maintenance of healthy state and physical and social activities is needed to maintain the national productivities. Among the diseases which deprive elderly people of activities and impose medical and care expenditure, cardiovascular diseases such as stroke, ischemic heart disease, heart failure and renal failure take major parts. These cardiovascular diseases occur based on the development and progression of arteriosclerotic vascular lesions, namely, vascular aging. Because hypertension is a major risk factor for vascular aging, the adequate control of blood pressure is pivotally important in order to prevent the incidence of cardiovascular events in the later stage of life. This is also concerned with the socio-economical issues and national productivity.

Keywords: Hypertension, Vascular aging, Atherosclerosis, Antihypertensive drugs

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Fig. 1.

Cascade from the life-style related diseases to the occurrence of cardiovascular diseases via risk factors and vascular aging. Met-s, metabolic syndrome; TNF-α, chronic kidney disease; FFA, free fatty acid; CKD, chronic kidney disease; LVH, left ventricular hypertrophy.

Fig. 2.

Outlines of the renin-angiotensin-aldosterone system and its biological actions. ACE, angiotensin-converting enzyme.

Fig. 3.

Changes in the parameters of renal function along with the progression of renal dysfunction.

Fig. 4.

Circulating components of renin-angiotensin-aldosterone system in hypertensive patients given the combination of angiotensin II receptor antagonist (olmesartan) with thiazide or calcium channel blocker (azelnidipine). *p < 0.05, ^†p < 0.01.

Fig. 5.

Markers of oxidative stress, inflammation and arterial stiffness in hypertensive patients given the combination of angiotensin II receptor blocker with thiazide or calcium channel blocker. LDL, low-density lipoprotein. hsCRP: high-sensitivity C-reactive protein, CAVI: cardio-ankle vascular index. *p < 0.05, †p < 0.01.

Fig. 6.

Glomerular filtration rate (GFR), serum low-density lipoprotein-cholesterol (LDL-C) and cardio-ankle vascular index (CAVI) in hyperteisive chronic kidney disease patients given the combination of angiotensin-converting enzyme inhibitor (ACEI) with thiazide or calcium channel blocker (CCB). *p < 0.05, ^†p < 0.01.

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