Omapatrilat Reduces Pulse Pressure and Proximal Aortic Stiffness in Patients With Systolic Hypertension

Author:

Mitchell Gary F.1,Izzo Joseph L.1,Lacourcière Yves1,Ouellet Jean-Pascal1,Neutel Joel1,Qian Chunlin1,Kerwin Linda J.1,Block Alan J.1,Pfeffer Marc A.1

Affiliation:

1. From Cardiovascular Engineering, Inc (G.F.M.), Holliston, Mass; State University of New York at Buffalo (J.L.I.), Buffalo, NY; Centre hospitalier de l’Universite Laval (Y.L.), Ste Foy, Quebec; Q&T Research, Inc (J.-P.O.), Sherbrooke, Quebec, Canada; Orange County Research Center (J.N.), Orange, Calif; Bristol-Myers Squibb Pharmaceutical Research Institute (C.Q., L.J.K., A.J.B.), Princeton, NJ; and Brigham and Women’s Hospital (M.A.P.), Boston, Mass.

Abstract

Background Increased pulse pressure, an indicator of conduit vessel stiffness, is a strong independent predictor of cardiovascular events in hypertensive cohorts, which suggests that reduction of conduit vessel stiffness may be desirable in hypertension. Methods and Results We assessed changes in pulse pressure and conduit vessel stiffness in a 12-week double-blind, randomized clinical trial that compared monotherapy with the ACE inhibitor enalapril 40 mg daily (n=87) versus the vasopeptidase (dual ACE and neutral endopeptidase) inhibitor omapatrilat 80 mg daily (n=80) in patients with systolic hypertension. Patients were withdrawn from antihypertensive medications 1 to 2 weeks before enrollment, and systolic pressure was confirmed to be ≥160 mm Hg. With the use of calibrated tonometry and pulsed Doppler, pulsatile hemodynamics were assessed before randomization and at 12 weeks. Characteristic impedance (Z c ), a direct measure of the stiffness of the central aorta, was calculated from the ratio of changes in carotid pressure and aortic flow in early systole. Omapatrilat compared with enalapril produced greater reductions in peripheral (−8.2±12.2 versus −4.0±12.2 mm Hg, P <0.05) and central (−10.2±16.2 versus −3.2±16.9 mm Hg, P <0.01) pulse pressures and Z c (237±83 to 208±70 versus 225±87 to 231±94 dyne · s/cm 5 , P <0.001); the latter remained significant ( P <0.05) after adjusting for change in mean pressure. Conclusions Greater reductions in pulse pressure and Z c in hypertensive subjects treated with omapatrilat compared with enalapril suggest that aortic stiffness is maintained by specific, partially reversible mechanisms and underscore a potential role for pharmacological modulation of natriuretic peptides in the treatment of hypertension.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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