The main objective of this study was to assess whether aspirin 100 mg QD can improve blood pressure (BP) control and endothelial function in subjects with arterial hypertension (AH) and hypercholesterolaemia. In total, 21 patients of both sexes (52.1±11.5 years) with treated AH and hypercholesterolaemia on antihypertensive and statin therapy were included in the treatment group. In the control group, 20 matched patients of both sexes (51.3±12.7 years), but without statin therapy, were recruited. Treatment group subjects received aspirin (100 mg QD) for a duration of 12 weeks at randomization ( Treatment phase-1 ), followed by single blind matching placebo for 12 weeks ( Placebo phase ) and then again received aspirin (100 mg QD) for an additional 12 weeks ( Treatment phase-2 ). The control group participated in Treatment phase-1, but did not continue Placebo phase and Treatment phase-2. At randomization and at the end of each study phase, mean 24-h systolic BP (SBP) and diastolic BP (DBP) were assessed by 24-h ambulatory blood pressure monitoring (ABPM) and endothelium-dependent (flow mediated, FMD) and -independent (nitroglycerin induced, NTG) vasodilatations of brachial artery were measured using high-resolution ultrasound. In Treatment phase-1, reduction of SBP and DBP (ΔSBP 5.7±2.6 mmHg, P =0.008; ΔDBP 3.8±1.7 mmHg, P =0.014) and improvement of FMD (4.1±0.6%, P =0.019), in Placebo phase an elevation of SBP and DBP (ΔSBP −6.2±2.9 mmHg, P =0.002; ΔDBP −4.2±1.9 mmHg, P =0.031) and worsening of FMD (−3.8±0.9%, P =0.027), and in Treatment phase-2 reduction of SBP and DBP (ΔSBP 4.9±2.3 mmHg, P =0.005; ΔDBP 4.1±1.3 mmHg, P =0.024) and improvement of FMD (4.5±1.3%, P =0.009) were observed in the treatment Group but not in the control group. Addition of low-dose aspirin to antihypertensive medications and statins in hypertensive and hypercholesterolaemic subjects can reduce both SBP and DBP by improvement of endothelial function.

Background: Hypertension is considered resistant if blood pressure cannot be reduced to < 140/90 mmHg with an appropriate triple-drug regimen, including an oral diuretic, with all agents administered at maximal dosages. This definition has evolved with the development of new therapies and evidence-based data supporting treatment to lower BP goals.Objective: To assess whether vitamin C and atorvastatin improve endothelial function and blood pressure control in subjects with resistant arterial hypertension and dyslipidemia.Methods: Forty-eight hyperlipidemic subjects with RH (office systolic BP >140 mmHg and/or office diastolic BP >90 mmHg notwithstanding antihypertensive treatment with three medications in maximal doses) were randomized into three groups to receive additional medication for 8 weeks. Group VTC (n = 17) - mean 24 hour SBP 150.6 +/- 5.2 mmHg, DBP 86.1 +/- 3.3 mmHg, low density lipoprotein 158.1 +/- 24.5 mg/dl - received vitamin C 500 mg per day; Group ATR (n = 15) - mean 24 hour SBP 153.1 +/- 4.8 mmHg, DBP 87.1 +/- 6.7 mmHg, LDL 162.6 +/- 13.6 mg/dl - received atorvastatin 20 mg/day; and Group PLA (n = 16) - mean 24 hour SBP 151.1 +/- 7.4 mmHg, DBP 84.8 +/- 5.9 mmHg, LDL 156.7 +/- 26.1 mg/dl - received a placebo. High resolution ultrasound was used to calculate brachial artery flow-mediated dilation, and 24 hour ambulatory BP monitoring was performed at study entry and after 8 weeks.Results: In the ATR group there were significant reductions of SBP (DeltaSBP1-2:13.7 +/- 5.6 mmHg, P 0.001), DBP (DeltaDBP1-2:7.8 +/- 5.7 mmHg, P 0.01), LDL (DeltaLDL1-2: 67.7 +/- 28.3 mg/dl, P < 0.001) and improvement of brachial artery FMD (DeltaFMD2-1: 4.2 +/- 2.6%). No significant changes in BP, LDL and FMD were observed in the other two groups.Conclusions: In subjects with RH and dyslipidemia, atorvastatin 20 mg/day compared to vitamin C 500 mg/day may help to achieve better BP control and improve endothelial function in a finite period. A larger trial is needed to assess the drug's efficacy in this population for longer periods.

Background: Type II diabetes is often associated with high blood pressure, elevated sympathetic activity, and high plasma insulin levels. Hypoglycemic agents may negatively interfere with blood pressure control, sympathetic activity, and plasma insulin level; therefore the choice of treatment in type II diabetes may be crucial. We aimed to compare the effects of two hypoglycemic drugs on blood glucose, blood pressure, sympathetic activity, and insulin levels in type II diabetic and hypertensive patients. Methods: Forty-eight (24M, 24F) type II diabetic, hypertensive, and hyperlipidemic subjects were enrolled and treated for 4 weeks with an ACE inhibitor (Cilazapril) and a statin (Simvastatin). They were then randomized into two groups to receive a thiazolidinedione (Rosiglitazone; ROS) or a sulfonylurea (Glibenclamide; GLB) for 8 weeks. Blood biochemistry, blood pressure, plasma insulin, endothelial function, and sympathetic skin activity were measured before and after treatment. Results: A significant drop in systolic and diastolic blood pressure by 6.1 ± 4.1mm Hg and 4.2 ± 1.9 mm Hg respectively; a reduction in plasma insulin concentration by 4.3 ± 1.9mU/L and a decline in skin sympathetic activity were observed in the group receiving ROS. The GLB group showed an increase in systolic blood pressure by 3.1 ± 2.5 mm Hg, no change in diastolic blood pressure, significant elevation in plasma insulin concentration by 2.3 ± 1.4 mu/L, and augmentation of sympathetic activity. No significant changes in endothelial function were observed in either group. Conclusions: Rosiglitazone improved both plasma glucose and blood pressure levels, probably by attenuation of hyperinsulinemia and sympathetic activity, while Glibenclamide worsened blood pressure control possibly by elevation of insulin levels and activation of the sympathetic system.

Hypertension and knee osteoarthritis (OA) are frequent comorbidities. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to relieve pain in such patients. In the last decade selective NSAIDs are used more commonly since they lead to less gastrointestinal complications. As has been shown, the treatment with NSAIDs may cause a mild rise of arterial blood pressure (BP). The influence of selective NSAIDs on BP, particularly in hypertensive patients has still to be investigated. The aim of this study was to determine arterial BP changes in patients suffering from stable arterial hypertension and knee OA and treated with rofecoxib or nabumetone. Two groups of patients with knee OA and stable arterial hypertension received either 25 mg rofecoxib once daily or namebutone 2000 mg once daily during the first week of treatment and 1000 mg for the following 3 weeks. Twenty-four hour arterial BP monitoring was performed prior to initiation of treatment and at the end of a 4-week period. The results were that no changes were found in the mean systolic and diastolic characteristics of BP in the rofecoxib treatment group during day time (delta systolic BP −0.4 mm Hg and delta diastolic BP −0.4 mm Hg), while nocturnal BP increased significantly: delta systolic BP +15.7 mm Hg and delta diastolic BP +8.5 mm Hg. The mean systolic arterial pressure in the nabumeton group raised delta systolic BP 2.9 mm Hg in the daytime and 5 mm Hg during the night-time after the treatment. The mean diastolic arterial pressure also rose delta diastolic 3.2 mm Hg and 4.9 mm Hg at day and night hours respectively. In conclusion rofecoxib treatment did not change arterial BP during day time hours, however, there was a distinct increase in night-time systolic and diastolic BP leading to a disappearance of the physiological diurnal variation. Nabumetone caused a moderate increase of day and night BP, without changes in biological diurnal variation.

It is still uncertain whether improvement of endothelial function by HMG-CoA reductase inhibitors may assist to better blood pressure control in hypertensive patients. This study aimed to examine the effects of coadministration of low dose Aspirin and Simvastatin on blood pressure, on endothelial function, tonus and elasticity of brachial artery in non-hyperlipidemic, treated hypertensive subjects. 23 non-hyperlipidemic (LDL = 106,4±16,3mg/dl) subjects (M:14, F:9) with treated arterial hypertension, (BP syst 148.4±9.05mm/Hg, BP diast 82.4±4.7mm/Hg) 21 to 70 years of age (mean 54±12) were randomized in two groups to receive in addition to their antihypertensive medications: Group A: Aspirin 75mg per day for 8 weeks, Group B: The same+ Simvastatin 10mg/day for the first 4 weeks. Using high resolution ultrasound, brachial artery diameter was measured at rest and during reactive hyperemia (RH) after 4.5min. of pressure 250mm/Hg on forearm, (with flow increase causing endothelial-dependent dilation,) Flow mediated dilation (FMD) was calculated. Brachial artery tonus and elasticity were measured by analyzing pulsatile variations and brachial artery pulse contour, using pulse echo ultrasound (Device the Ultrasound brain Vessel Scanner. Inta Medics Ltd. Israel). In the group B we observed a significant reduction of both systolic (17,8±4,7mm/Hg, p< 0.001) and diastolic (6,01±2,08mm/Hg, p<0.05) blood pressure, improvement of FMD (ΔFMD2-1 17,2 ± 6,3 %, p < 0.001) and tonus (T1/T2 147,3±14,8%, p < 0.001) of brachial artery after one month, while discontinuation of simvastatin there was elevation of systolic (ΔSBP3–2 8,99±3,61 mm/Hg, p< 0.05) and diastolic (ΔDBP3-2 4,13 ±2,96mm/Hg, p < 0.05) blood pressure and deterioration of FMD (ΔFMD3-2 13.3±5,9%, p<0.001). In the group A no significant changes in any parameter was seen along the two months. Brachial artery elasticity was not changed in both groups. Simvastatin 10mg/d improves (while aspirin 75 mg/d does not) endothelial dysfunction in non-hyperlipidemic hypertensive subjects and may assist to better blood pressure control.

Halomeiser, E.; Magen, E.; Viskoper, J. R.; Priluk, R.; Last, A.; London, D.; Altshuler, A. Author Information

We have recently reported that dietary fish oil supplementation (n-3) polyunsaturated fatty acid (PUFA) led to a reduction in blood pressure (BP) and serum triglycerides (TG), in addition to the normalization of the hypercoagulable state in subjects with obesity, hypertension and dyslipidemia without diabetes mellitus (OHD-DM). The aim of the present study was to explore the mechanism of this amelioration by comparing the previous results to those obtained from 19 subjects who, in addition to the conditions described above, also suffer from diabetes mellitus (OHD+DM) and proteinuria. In both the non-diabetic and diabetic groups, a similar reduction was observed in BP (from 158.7/80.8 to 146/72.9 mmHg, and from 157.6/83.2 to 141.9/75.6 mmHg, respectively, P<0.001) and TG levels (from 159.2 to 108.0 mg/dl and from 208.7 to 153.1 mg/dl, respectively, P<0.001). However, a favorable reduction in hemostasis parameters (platelet aggregation on extracellular matrix and (alpha2-antiplasmin) was only seen among the nondiabetic patients (from 12.1+/-4.9 to 4.2+/-3.2%, P<0.001). This difference may stem from a less efficient exchange between n-3 and n-6 PUFA in serum phospholipid of the OHD+DM patients. Overall, this 13-day fasting/refeeding method developed by us has proven to cause the rapid exchange of arachidonic acid for eicosapentaenoic acid. It appears to be an effective regimen for the reduction of cardiovascular risk factors (BP, TG and hemostatic variables) in OHD-DM patients and to a lesser extent in OHD+DM patients.