gms | German Medical Science

Background: Experimental studies revealed pro-inflammatory properties of angiotensin II. We evaluated anti-inflammatory effects of the angiotensin II subtype 1-receptor antagonist olmesartan medoxomil alone and in co-therapy with the HMG-CoA-reductase-inhibitor pravastatin in patients with essential hypertension and micro-inflammation.

Methods and Results: We measured a panel of vascular inflammation markers including high-sensitivity C-reactive protein (hsCRP) and lipid levels during 12 weeks of therapy with olmesartan (n = 100) or placebo (n = 99) in a prospective double-blind multi-center study. Pravastatin was added to the double-blind therapy at week 6 in both treatment arms. Blood pressure control was achieved with addition of hydrochlorothiazide. Olmesartan treatment significantly reduced serum levels of hsCRP (-15.1%; p<0.05), high-sensitivity tumor necrosis factor-Ą (hsTNF-Ą; -8.9%; p<0.02), interleukin-6 (IL-6; -14.0%; p<0.05) and monocyte chemotactic protein-1 (MCP-1; -6.5%; p<0.01) already after 6 weeks of therapy, whereas placebo treatment (i.e. blood pressure reduction) had no major effect on inflammation markers. After 12 weeks of therapy hsCRP (-21.1%; p<0.02), hsTNF-Ą (-13.6%; p<0.01) and IL-6 (-18.0%; p<0.01) decreased further with olmesartan and pravastatin co-therapy, but treatment with pravastatin alone (i.e. co-therapy with placebo) did not significantly alter inflammation markers. In contrast, addition of pravastatin lead to a significant reduction (p<0.001) of low-density lipoprotein cholesterol serum concentrations in the olmesartan and placebo treatment group (-15.1% and -12.1% respectively).

Conclusions: Angiotensin II-receptor blockade significantly reduces vascular micro-inflammation in patients with essential hypertension already after 6 weeks of therapy. This anti-inflammatory action of angiotensin II-receptor antagonists may contribute to their beneficial cardiovascular effects.