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Effects of the Angiotensin II Type 1 Receptor Antagonist Valsartan on the Expression of Superoxide Dismutase in Hypertensive Patients

From the Division of Cardiology, Taipei Medical University-Wan Fang Hospital (Dr Yang, Dr Kao, Dr Chan); Faculty of Chinese Medicine, Macau University of Science and Technology, Macau (Dr Chan); the Faculty of Medicine, the Chinese University of Hong Kong (Dr Tomlinson); and the Division of Cardiology, Cathay General Hospital, Taipei, Taiwan (Dr Ko).

The role of oxidative stress in the pathogenesis of vascular diseases such as hypertension has been well recognized. Angiotensin (Ang) II is regarded as a pro-oxidant because it can stimulate the production of reactive oxygen species. The purpose of this study was to evaluate whether treatment with the Ang II type 1 (AT₁) receptor antagonist valsartan has an antioxidant effect in patients with mild to moderate hypertension. A randomized, double-blind, placebo-controlled study was conducted in 48 stage I and II hypertensive subjects. Patients were followed every 4 weeks for 12 weeks after randomization to valsartan titrated to 80 to 160 mg once or twice daily or matching placebo. The erythrocyte superoxide dismutase (SOD) activity and expression of SOD-mRNA in polymorphonuclear leukocytes were measured before and after treatment. Valsartan showed concentration-dependent inhibition of reactive oxygen species generation in polymorphonuclear leukocytes from hypertensive patients. The erythrocyte superoxide dismutase activity before treatment was more than 2 times higher in hypertensive subjects compared to normal controls. Superoxide dismutase activity decreased significantly after 12 weeks of treatment with valsartan but did not change with placebo. The amount of SOD-mRNA in the polymorphonuclear leukocytes decreased progressively over 3 months in the hypertensive subjects receiving valsartan treatment but did not change in the placebo group. The production of reactive oxygen species is increased in hypertension, and superoxide dismutase activity is increased, presumably as a compensatory mechanism. Treatment with valsartan but not placebo resulted in a progressive down-regulation of SOD-mRNA expression and a reduction in superoxide dismutase activity, suggesting antioxidant activity and a reduction of reactive oxygen species generation. These findings imply that AT₁ receptor antagonists may provide benefits to hypertensive patients beyond blood pressure reduction.

Key Words: gene • hypertension • reactive oxygen species • superoxide dismutase • valsartan

Address for reprints: Address for correspondence: Paul Chan, MD, PhD, Division of Cardiology, Taipei Medical University-Wan Fang Hospital, No 111, Hsing-Lung Road, Sec. 3, Wen-Shan District, Taipei City 116, Taiwan; e-mail: chanpaul{at}wanfang.gov.tw.