Reduction in Arterial Stiffness With Angiotensin II Antagonism and Converting Enzyme Inhibition: A Comparative Study Among Malay Hypertensive Subjects With a Known Genetic Profile

Background Data comparing the effect of losartan and perindopril on aortic stiffness among hypertensive subjects without A1166C polymorphism was not available. Methods The short-term and long-term effects of losartan (50 mg) and perindopril (4 mg) on aortic stiffness measured as carotid femoral pulse wave velocity (PWV) were compared in 39 middle-aged Malay subjects with mild-to-moderate hypertension in a 4-month, double-blind, randomized, controlled, parallel-design study. Results Four-month treatment with both drugs showed a significant reduction in blood pressure (BP) (P< .005) and PWV (P< .05) as compared to the baseline. On the other hand 1-month treatment showed a significant reduction in BP only in perindopril group (P< .05) but not in the losartan group. There was no significant reduction in pulse pressure and PWV after 1 month treatment by both drugs. No significant difference was seen in reduction in BP after 1 month and 4 months treatment between the two drugs. Similarly no significant difference was seen in reduction in PWV between the two drugs after 1 month (P = .613) and 4 months (P = .521) of treatment. Reduction in PWV by losartan (r = 0.470) and perindopril (r = 0.457) correlated significantly only with reduction in DBP (P< .05) and remained significant even after controlling for reduction in DBP (P< .05). Reduction in PWV by both losartan and perindopril was independent of reduction in BP by these drugs. Conclusions These results showed that long-term treatment with losartan shows similar pressure independent reduction in PWV as perindopril among Malay hypertensive subjects with a homogenous “AA” genotype for angiotensin II type 1 receptor and may serve as a suitable alternative to perindopril.