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Current Vascular Pharmacology


ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Research Article

Adherence to Treatment, Arterial Stiffness and Cognitive Function in Irbesartan- Treated Newly Diagnosed Hypertensive Patients

Author(s): Rigas G. Kalaitzidis*, Olga Balafa, Evangelia Dounousi, Dimitrios Stagikas and Vasilios Tsimihodimos

Volume 19, Issue 5, 2021

Published on: 20 November, 2020

Page: [565 - 571] Pages: 7

DOI: 10.2174/1570161119666201120160104

Price: $65


Objective: Non-adherence to antihypertensive agents leads to reduced blood pressure (BP) control. Data supporting the correlation of adherence with arterial stiffness (AS) are few. Furthermore, the causal relationship between AS and cognitive dysfunction (CO/DY) has not been clearly established. It is suggested that angiotensin II receptor blockers (ARBs) exhibit the lowest discontinuation rate among antihypertensive drugs.

Design and Methods: We followed up with patients receiving monotherapy with irbesartan. CO/DY was assessed with the Mini-Mental State Examination (MΜSE) and other tests.

Results: Patients [n=77; mean age: 56±11 years; 39 men (50.6%)] were followed-up for 16.1±10.9 months. At the end of follow up, significant reductions were observed in mean peripheral systolic BP (135±117 vs 153±11 mmHg; p<0.005), mean peripheral diastolic BP (85±11 vs 95±10 mmHg; p<0.005), mean central systolic BP (130±11 vs 142±12 mmHg; p<0.005) as well as in mean central diastolic BP (85±8 vs 95±97 mmHg; p<0.005).

AS indices [carotid-femoral pulse wave velocity and augmentation index] also improved significantly: 7.7±1.4 vs 8.2±1.4 m/sec (p<0.005), and 29.1±8.3 vs 32.3±9.1 (p<0.005), respectively.

At the end of the study, a significant improvement was observed in the MMSE test (29.7±0.7 vs. 29.2±0.9; p<0.02), as well as a significant reduction in 24h urine albumin (94±82 vs. 204±112 mg/24h, p<0.005).

The level of adherence was high in 60/77 (77.9%), medium in 9/77 (11.6%) and low in 8/77 (10.38%) patients.

Conclusion: Hypertensive patients receiving mono-therapy with an ARB showed reduced AS, cognitive improvement, significant reductions in BP (peripheral and central) and decreased 24h urinary albumin excretion.

Keywords: Hypertension, adherence to treatment, arterial stiffness, cognitive function, angiotensin II receptor antagonists.

Graphical Abstract
Hales CM, Carroll MD, Simon PA, Kuo T, Ogden CL. Hypertension Prevalence, Awareness, Treatment, and Control Among Adults Aged ≥18 Years - Los Angeles County, 1999-2006 and 2007-2014. MMWR Morb Mortal Wkly Rep 2017; 66(32): 846-9.
[] [PMID: 28817553]
Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008; 336(7653): 1114-7.
[] [PMID: 18480115]
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353(5): 487-97.
[] [PMID: 16079372]
Costa FV. Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment. High Blood Press Cardiovasc Prev 2017; 24(3): 265-74.
[] [PMID: 28695464]
Andrade SE, Kahler KH, Frech F, Chan KA. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 2006; 15(8): 565-74.
[] [PMID: 16514590]
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol 1997; 50(1): 105-16.
[] [PMID: 9048695]
Wannemacher AJ, Schepers GP, Townsend KA. Antihypertensive medication compliance in a Veterans Affairs Healthcare System. Ann Pharmacother 2002; 36(6): 986-91.
[] [PMID: 12022897]
Okano GJ, Rascati KL, Wilson JP, Remund DD, Grabenstein JD, Brixner DI. Patterns of antihypertensive use among patients in the US Department of Defense database initially prescribed an angiotensin-converting enzyme inhibitor or calcium channel blocker. Clin Ther 1997; 19(6): 1433-45.
[] [PMID: 9444451]
Bramley TJ, Gerbino PP, Nightengale BS, Frech-Tamas F. Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations. J Manag Care Pharm 2006; 12(3): 239-45.
[] [PMID: 16623608]
Hill MN, Miller NH, DeGeest S. American Society of Hypertension Writing Group. ASH position paper: Adherence and persistence with taking medication to control high blood pressure. J Clin Hypertens (Greenwich) 2010; 12(10): 757-64.
[] [PMID: 21029338]
Psaty BM, Koepsell TD, Wagner EH, LoGerfo JP, Inui TS. The relative risk of incident coronary heart disease associated with recently stopping the use of beta-blockers. JAMA 1990; 263(12): 1653-7.
[] [PMID: 1968518]
Tuokko H, Hadjistavropoulos T, Miller JA, Beattie BL. The Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease. J Am Geriatr Soc 1992; 40(6): 579-84.
[] [PMID: 1587974]
Teng EL, Chui HC, Schneider LS, Metzger LE. Alzheimer’s dementia: performance on the Mini-Mental State Examination. J Consult Clin Psychol 1987; 55(1): 96-100.
[] [PMID: 3571664]
Barberger-Gateau P, Commenges D, Gagnon M, Letenneur L, Sauvel C, Dartigues JF. Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. J Am Geriatr Soc 1992; 40(11): 1129-34.
[] [PMID: 1401698]
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-1983; 17(1): 37-49.
[] [PMID: 7183759]
Schofield I, Stott DJ, Tolson D, McFadyen A, Monaghan J, Nelson D. Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test. Eur J Emerg Med 2010; 17(6): 340-2.
[] [PMID: 20164778]
de Medeiros K, Robert P, Gauthier S, et al. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010; 22(6): 984-94.
[] [PMID: 20594384]
Huybrechts SA, Devos DG, Vermeersch SJ, et al. Carotid to femoral pulse wave velocity: a comparison of real travelled aortic path lengths determined by MRI and superficial measurements. J Hypertens 2011; 29(8): 1577-82.
[] [PMID: 21666491]
Laurent S, Cockcroft J, Van Bortel L, et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27(21): 2588-605.
[] [PMID: 17000623]
Safar ME, Blacher J, Pannier B, et al. Central pulse pressure and mortality in end-stage renal disease. Hypertension 2002; 39(3): 735-8.
[] [PMID: 11897754]
Roman MJ, Devereux RB, Kizer JR, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension 2007; 50(1): 197-203.
[] [PMID: 17485598]
Smith RD, Yokoyama H, Averill DB, Schiffrin EL, Ferrario CM. Reversal of vascular hypertrophy in hypertensive patients through blockade of angiotensin II receptors. J Am Soc Hypertens 2008; 2(3): 165-72.
[] [PMID: 20409899]
Spanos G, Kalaitzidis R, Karasavvidou D, Pappas K, Siamopoulos KC. Efficacy of aliskiren and valsartan in hypertensive patients with albuminuria: a randomized parallel-group study. J Renin Angiotensin Aldosterone Syst 2013; 14(4): 315-21.
[] [PMID: 23132848]
Holtkamp FA, de Zeeuw D, de Graeff PA, et al. Albuminuria and blood pressure, independent targets for cardioprotective therapy in patients with diabetes and nephropathy: a post hoc analysis of the combined RENAAL and IDNT trials. Eur Heart J 2011; 32(12): 1493-9.
[] [PMID: 21421598]
Cetinkalp SS, Karadeniz MM, Erdogan MA, Ozgen GA, Yilmaz CO. Short-term effects of irbesartan treatment on microalbuminuria in patients with normotensive type 2 diabetes. Saudi Med J 2008; 29(10): 1414-8.
[PMID: 18946564]
Pannozzo MA, Holland PR, Scullion G, Talbot R, Mullins JJ, Horsburgh K. Controlled hypertension induces cerebrovascular and gene alterations in Cyp1a1-Ren2 transgenic rats. J Am Soc Hypertens 2013; 7(6): 411-9.
[] [PMID: 24119481]
Kandil H, Soliman A, Taher F, et al. A novel computer-aided diagnosis system for the early detection of hypertension based on cerebrovascular alterations. Neuroimage Clin 2020; 25: 102107.
[] [PMID: 31830715]
Xu G, Bai F, Lin X, et al. Association between Antihypertensive Drug Use and the Incidence of Cognitive Decline and Dementia: A Meta-Analysis of Prospective Cohort Studies. BioMed Res Int 2017; 2017: 4368474.
[] [PMID: 29094046]
Rouch L, Cestac P, Hanon O, et al. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs 2015; 29(2): 113-30.
[] [PMID: 25700645]
Demir M, Gürol AO, Özyiğit RT, Üresin AY. Effects of Blood Pressure Lowering With Different Antihypertensive Agents on Cognitive Function and Plasma Brain-derived Neurotrophic Factor Levels: A Comparative Study. J Cardiovasc Pharmacol 2016; 67(6): 538-43.
[] [PMID: 26906033]
Peters R, Yasar S, Anderson CS, et al. Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis. Neurology 2020; 94(3): e267-81.
[] [PMID: 31827004]
Kherada N, Heimowitz T, Rosendorff C. Antihypertensive Therapies and Cognitive Function: a Review. Curr Hypertens Rep 2015; 17(10): 79.
[] [PMID: 26298567]
Zhuang S, Li J, Wang X, et al. Renin-angiotensin system-targeting antihypertensive drugs and risk of vascular cognitive impairment: A meta-analysis. Neurosci Lett 2016; 615: 1-8.
[] [PMID: 26797651]
Stuhec M, Keuschler J, Serra-Mestres J, Isetta M. Effects of different antihypertensive medication groups on cognitive function in older patients: A systematic review. Eur Psychiatry 2017; 46: 1-15.
[] [PMID: 28992530]
Fisher CM. The arterial lesions underlying lacunes. Acta Neuropathol 1968; 12(1): 1-15.
[] [PMID: 5708546]
Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 2003; 107(22): 2864-9.
[] [PMID: 12796414]
Mahmud A, Feely J. Effect of angiotensin ii receptor blockade on arterial stiffness: beyond blood pressure reduction. Am J Hypertens 2002; 15(12): 1092-5.
[] [PMID: 12460706]
Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003; 326(7404): 1427.
[] [PMID: 12829555]
Corrao G, Parodi A, Nicotra F, et al. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens 2011; 29(3): 610-8.
[] [PMID: 21157368]
Cho MH, Shin DW, Chang SA, et al. Association between cognitive impairment and poor antihypertensive medication adherence in elderly hypertensive patients without dementia. Sci Rep 2018; 8(1): 11688.
[] [PMID: 30076332]
Butler MJ, Tanner RM, Muntner P, et al. Adherence to antihypertensive medications and associations with blood pressure among African Americans with hypertension in the Jackson Heart Study. J Am Soc Hypertens 2017; 11(9): 581-8.
[] [PMID: 28895842]
Kalaitzidis RG, Panagiotopoulou T, Stagikas D, Pappas K, Balafa O, Elisaf MS. Arterial Stiffness, Cognitive Dysfunction and Adherence to Antihypertensive Agents. Is there a Link to Hypertensive Patients? Curr Vasc Pharmacol 2020; 18(4): 410-7.
[] [PMID: 30987567]
Williams B, Mancia G, Spiering W. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 19: 3-73.
Reklou A, Katsiki N, Karagiannis A, Athyros V. Effects of Lipid Lowering Drugs on Arterial Stiffness: One More Way to Reduce Cardiovascular Risk? Curr Vasc Pharmacol 2020; 18(1): 38-42.
[] [PMID: 30663570]
Zanoli L, Mikhailidis DP, Bruno RM, et al. Aortic Stiffening Is an Extraintestinal Manifestation of Inflammatory Bowel Disease: Review of the Literature and Expert Panel Statement. Angiology 2020; 71(8): 689-97.
[] [PMID: 32292048]

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