Effect of crossing over hypertensive patients from a beta-blocker to an angiotensin receptor antagonist on resistance artery structure and on endothelial function
Bibliographic record
Abstract
BACKGROUND: Treatment of essential hypertensive patients with an AT1 angiotensin receptor antagonist has previously resulted in correction of resistance artery structure and endothelial function, whereas in a parallel group treated with the beta-blocker atenolol there was no improvement of altered vascular structure and function. To test the hypothesis that patients previously treated with atenolol could present improvement of vascular structure and endothelial function if they were subjected to blockade of the renin-angiotensin system, we crossed over hypertensive patients that had been randomized to treatment with the beta-blocker atenolol to treatment with the AT1 antagonist irbesartan, and studied small artery structure and endothelial function before and after treatment. METHODS: Eleven essential hypertensive patients (51 +/- 2 years, range 38-65; 75% male) that had previously been randomized to treatment with atenolol and treated for 1 year with good blood pressure control, were crossed over to treatment with the AT1 antagonist irbesartan for 1 year. Small resistance arteries were dissected from gluteal subcutaneous biopsies that were performed before and after 1 year of treatment. The structure and endothelial function of the resistance arteries were studied on a pressurized myograph. RESULTS: Blood pressure control (129 +/- 3.3/85 +/- 1.8 mmHg) was identical to that achieved previously with atenolol (131 +/- 3.3/84 +/- 1.1 mmHg). Following 1 year of treatment, the arterial media width to lumen ratio (M/L) of resistance arteries (lumen diameter, 150-350 microm), which had remained unchanged under atenolol treatment, decreased from 8.44 +/- 0.45% when patients were on atenolol, to 6.46 +/- 0.30%, P < 0.01, when patients received irbesartan. Maximal acetylcholine-induced endothelium-dependent relaxation was 81.1 +/- 4.1% when patients were on atenolol, unchanged from before starting treatment with the beta-blocker, and was normalized by irbesartan (to 94.8 +/- 2.0%, P < 0.01). CONCLUSION: Crossing over essential hypertensive patients with well-controlled blood pressure from the beta-blocker atenolol to the AT1 receptor antagonist irbesartan resulted in correction of previously persistently altered vascular structure and endothelial function, suggesting a structural and endothelial vascular protective effect of antihypertensive treatment with the AT1 receptor antagonist.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".