Effects of valsartan on left ventricular diastolic function in patients with mild or moderate essential hypertension: Comparison with enalapril

Effects of valsartan on left ventricular diastolic function in patients with mild or moderate essential hypertension: Comparison with enalapril (80 visite)

Cuocolo A, Storto G, Izzo R, Iovino GL, Damiano M, Bertocchi F, Mann J, Trimarco B

Journal Of Hypertension (ISSN: 0263-6352), 1999 Dec; 17(12): 1759-1766.

Tipo di articolo: Journal Article,

Impact factor: 3.039, Impact factor a 5 anni: 4.699

Url: http://www.scopus.com/inward/record.url?eid=2-s2.0-0032777331&partnerID=40&md5=917421822e0ffbd53a86702f767888b5

Parole chiave: Diastolic Function, Enalapril, Hypertension, Valsartan, Antihypertensive Agent, Adult, Article, Bicycle Ergometry, Clinical Article, Clinical Trial, Controlled Clinical Trial, Controlled Study, Crossover Procedure, Diastolic Blood Pressure, Double Blind Procedure, Essential Hypertension, Female, Heart Left Ventricle Filling, Heart Left Ventricle Function, Human, Oral Drug Administration, Priority Journal, Randomized Controlled Trial, Renin Angiotensin Aldosterone System, Systolic Blood Pressure, Angiography, Blood Pressure Monitoring, Ambulatory, Cross-Over Studies, Double-Blind Method, Exercise Test, Heart Rate, Middle Aged, Renin-Angiotensin System, Tetrazoles, Valine, Ventricular Function,

Affiliazioni:

Nucl. Med. Ctr. Natl. Cncl. of Res., Dept. Biomorphological Funct. Sci., University Federico II, Napoli, Italy
Dept. Clin. Med. Cardiovasc. Sci., University Federico II, Napoli, Italy
IRCCS Neuromed, Pozzilli, Italy
Novartis Pharma, Basle, Switzerland
Inst. Int. Med., Cardiol. Heart S., Università Federico II, Via Pansini 5, 80131 Napoli, Italy

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Gaash, W. H., Blaunstein, A. S., Andrias, C. W., Donahue, R. P., Avitall, B., Myocardial relaxation. II. Hemodynamic determinations of rate of left ventricular isovolumic pressure decline (1980) Am J Physiol, 239, pp. H1-H

Devoreux, R. B., Left ventricular diastolic dysfunction: Early diastolic relaxation and late diastolic compliance (1989) J Am Coll Cardiol, 13, pp. 337-339

Philips, R. A., Goldman, M. E., Ardeljan, M. A., Eison, H. B., Buyan, Y. U., Krakoff, L. R., Determinants of abnormal left ventricular filling in early hypertension (1989) J Am Coll Cardiol, 14, pp. 979-985

Choong, C. Y., Horrmann, H. C., Weymann, A. E., Fifer, M. A., Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans (1987) J Am Coll Cardiol, 10, pp. 800-808

Breisblatt, W. M., Wolf, C. J., McElhinny, B., Salerni, R., Smith, V. E., Comparison of ambulatory left ventricular ejection fraction and BP in systemic hypertension in patients with and without increased left ventricular hypertrophy (1993) Am Heart J, 125, pp. 1710-1716

Volpe, M., Rao, M. A. E., Cuocolo, A., Russo, R., Nappi, A., Mele, A. F., Radionuclide monitoring of cardiac adaptations to volume loading in patients with dilated cardiomyopathy and mild heart failure. Effects of angiotensin-converting enzyme inhibition (1995) Circulation, 92, pp. 2511-2518

Zusman, R. M., Christensen, D. M., Higgins, J., Boucher, C. A., Effects of fosinopril on cardiac function in patients with hypertension. Radionuclide assessment of left ventricular systolic and diastolic performance (1992) Am J Hypertens, 5, pp. 219-223

Goa, K. L., Wagstaff, A. J., Losartan potassium

Holwerda, N. J., Fogari, R., Angeli, P., Porcellati, C., Herreng, C., Oddou-Stock, P., Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: Efficacy and safety compared to placebo and onalapril (1996) J Hypertens, 14, pp. 1147-1151

Dovereux, R. B., Alonso, D. R., Lutas, E. M., Gottlieb, G. J., Campo, E., Sachs, I., Echocardiographic assessment of left ventricular hypertrophy

Bonow, R. O., Udelson, J. E., Left ventricular diastolic dysfunction as a cause of congestive heart failure (1992) Ann Intern Med, 117, pp. 502-510

Brutsaert, D. L., Sys, S. U., Relaxation and diastole of the heart (1989) Physiol Rev, 69, pp. 1228-1315

Hirsch, A. T., Tolsness, C. E., Smith, A. D., Schunkert, H., Ingelfinger, J. R., Dzau, U. J., Differential effects of captopril and enalapril on tissue renin-angiotensin system in experimental heart failure (1992) Circulation, 86, pp. 1566-1574

Grinstead, W. C., Young, J. B., The myocardial renin-angiotensin system: Existence, importance and clinical implications (1992) Am Heart J, 123, pp. 1039-1045

Brilla, G. C., Scheer, C., Rupp, H., Renin-angiotensin system and myocardial collagen matrix: Modulation of cardiac fibroblast function by angiotensin II type I receptor antagonism (1997) J Hypertens, 15 (6 SUPPL.), pp. 513-519

Objective. This study compares the effects of an AT1 angiotensin II receptor antagonist (valsartan) with those of an ACE inhibitor (enalapril) on left ventricular (LV) diastolic function in patients with mild or moderate essential hypertension and no evidence of LV hypertrophy at echocardiography. Methods. A total of 24 patients (16 men, mean age 47 ± 8 years) underwent radionuclide ambulatory monitoring (Vest) of LV function at rest and during upright bicycle exercise testing before and after two 4-week treatment periods with valsartan (80-160 mg/day orally) and enalapril (20-40 mg/day orally) according to a double-blind, crossover randomization scheme. Results. In the overall population no differences between the two treatments were found in LV peak filling rate (PFR) either at rest or at peak exercise. In a subgroup analysis it was found that baseline PFR was normal (= 2.5 EDV/sec) in 12 patients (subgroup A) and impaired (< 2.5 EDV/sec) in the remaining 12 (subgroup B). In both subgroups, valsartan and enalapril induced a significant and comparable reduction of systolic and diastolic blood pressure. In subgroup A, valsartan and enalapril did not induce significant changes in PFR. In subgroup B, valsartan increased PFR both at rest (from 2.0 ± 0.3 to 2.4 ± 0.3 EDV/sec, P < 0.01) and at peak exercise (from 4.1 ± 1.1 to 4.4 ± 1.0 EDV/s, P < 0.05), whereas enalapril did not change PFR either at rest (2.0 ± 0.4 EDV/s, P < 0.01 versus valsartan) or at peak exercise (3.7 ± 1.1 EDV/sec, P < 0.05 versus valsartan). Conclusions. Valsartan-induced renin-angiotensin system blockade is able to improve LV filling in patients with mild or moderate essential hypertension and impaired diastolic function. These findings support the hypothesis of a contribution of the renin-angiotensin system in the control of LV diastolic function in these patients.