Preview

Rational Pharmacotherapy in Cardiology

Advanced search

EFFECT OF ANGIOTENSIN-II RECEPTOR ANTAGONIST LOSARTAN AND ITS COMBINATION WITH DIURETICS ON MYOCARDIAL MORPHO-FUNCTIONAL CONDITIONS IN HYPERTENSIVE PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY

https://doi.org/10.20996/1819-6446-2008-4-1-67-75

Full Text:

Abstract

Aim. To compare the effects of long-term therapy with angiotensin-II receptor antagonist losartan, alone or in combination with hydrochlorothiazide, and amlodipine treatment on left ventricular morpho-functional variables and blood pressure (BP) in hypertensive patients.

Material and methods. 25 women and 27 men (average age 52,7±1,2 y.o.) with essential hypertension (1-2 grade) and left ventricular hypertrophy (LVH) were included into the study. After 3 week washout period the patients were randomized in 2:1 fashion to receive either losartan (n=34) or amlodipine (n=17). In 17 patients with insufficient response to losartan monotherapy (50-100mg/day) hydrochlorothiazide (12,5mg) was added to losartan (50mg) 4 weeks later. The daily dose of amlodipine was increased from 5 to 10 mg in 10 patients. At baseline and after 24 weeks of treatment 24-h BP monitoring and echocardiography (with evaluation of cardiac chamber dimensions, inter-ventricular septal and posterior wall thickness, left ventricular mass index -LVMI) were performed.

Results. 4-week losartan treatment significantly decreased clinic BP (-14,1±2,2/8,2±1,4 mm Hg, p<0,01), mean daily systolic and diastolic BP (-15,1±2,4 mm Hg and -8,9±1,7 mm Hg , p<0,001), mean day-time and night-time BP and systolic and diastolic BP load in 34 patients. Addition of hydrochlorothiazide induced a further decrease of mean night-time BP, pulse BP, improved circadian rhythm and normalized BP in 75% of patients compared with 50% in losartan alone. Significant decrease of clinic BP (-24,1±3,6/15,2±2,3, p<0,01), mean daily systolic and diastolic BP and BP load were noticed at 24 week of amlodipine treatment. Circadian BP rhythm didn’t change; night-time decrease of BP was insufficient. Antihypertensive efficacy was similar in both groups. Losartan, alone or combined with hydrochlorothiazide, caused regression of LVH in all patients, normalized geometry of left ventricle in 33% of patients and improved left ventricular diastolic function in 88,2% of patients. LVMI decreased due to reduction of wall thickness. Changes in LVMI, relative wall thickness and diastolic function in losartan group were greater than those obtained in amlodipine group.

Conclusion. Losartan, administered alone or combined with hydrochlorothiazide, has the greater effect on LVH, geometry and diastolic function of left ventricle compared with amlodipine. These results give evidence that losartan has cardioprotective and possibly other pleiotropic effects.

About the Authors

S. N. Tolpygina
State Research Center of Preventive Medicine of Rosmedtechnology, Moscow
Russian Federation


E. V. Oschepkova
Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research Complex of Rosmedtechnology, Moscow
Russian Federation


L. M. Sergakova
Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research Complex of Rosmedtechnology, Moscow
Russian Federation


A. N. Rogoza
Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research Complex of Rosmedtechnology, Moscow
Russian Federation


References

1. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens 1999;17:151-83.

2. Терапевтический справочник Вашингтонского университета. M: Практика, 1995

3. Burt VL, Cutler JA, Higgins M. et al. Trends in the prevalence, awareness, treatment and control of hypertension in the adult US population. Data from the Health examination surveys, 1960 to 1991. Hypertension.1995;26:60-9.

4. Беленков Ю.Н., Мареев В.Ю. Принципы рационального лечения сердечной недостаточности. М.: Медиа Медика, 2000.

5. Dahlof В., Devereux R., Kjeldsen S. et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet. 2002;359:995-1003.

6. Devereux RB, Okin PM, Roman MJ. Pre-clinical cardiovascular disease and surrogate end-points in hypertension: does race influence target organ damage independent of blood pressure? Ethn Dis 1998;8:138-48.

7. Pearson AC, Pasierski T, Labovits AJ. Left ventricular hypertrophy, diagnosis, prognosis, and management. Am Heart J. 1991;121(1Pt 1): 148-57.

8. Parving HH Microalbuminuria in essential hypertension and diabetes mellitus. J Hypertens Suppl. 1996,14:S89-94.

9. Yamazaki T, Komuro I, Yazaki Y Role of renin-angiotensin system in cardiac hypertrophy. Am J Cardiol 1999;83:53-7.

10. Weinberg MS, Weinberg AJ, Zappe DH. Effectively targeting the RAAS in cardiovascular and renal disease: rational for using angiotensin II receptor blockers in combination with angiotensin-con6verting enzyme inhibitors. J Renin Angiotensin Aldosterone Syst. 2000;1(3):217-33.

11. Сидоренко Б.А., Иосава И.К., Киктев В.Г., Преображенский Д.В. Блокаторы АТ1 - ангиотензиновых рецепторов как новая группа антигипертензивных препаратов. Клин фармакол тер. 1999;(8):38-45.

12. Mancia G., De Backer G., Dominiczak A. et al. 2007 Guidelines of the management of Arterial Hypertension: the Task Force for the management of arterial hypertension of the ESH and ESC. J Hypertens 2007; 25:1105-87.

13. Klingbeill AU, Schneider M, Martus P et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003;115:41- 6.

14. Ciulla MM, Paliotti R, Esposito A et al. Effect of the angiotensin receptor antagonist candesartan and the ACE inhibitor enalapril on ultrasound markers of myocardial fibrosis in hypertensive patients with left ventricular hypertrophy [abstract]. J Hypertens. 2005;23 (suppl 20):S381.

15. Ciulla MM., Paliotti R., Esposito A. et al. Different effects of antihypertensive therapies based on losartan or atenolol on ultrasound and biochemical markers of myocardial fibrosis: results of a randomized trial. Circulation 2004;110:552-7.

16. Terpstra WF, May JF, Smit AJ et al. Long-term effects of amlodipine and lisinopril on LVM and diastiolic function in elderly, previously untreated hypertensive patients: The ELVERA trial. J Hypertens 2001;19:303-9.

17. Devereux RB, Palmieri V, Sharpe N. et all. Effects of once-daily ACE inhibitor and calcium channel blockade-based antihypertensive treatment regimens on LVH and diastolic filling in hypertension. The Prospective Randomised Enalapril Study Evaluating Regression of Left ventricular Enlargement (PRESERVE) trial. Circulation 2001;104:1248-54.

18. Zanchetti A, Ruilope LM, Cuspidi C et al. Comparative effects of the ACE inhibitor fosinopril and the calcium antagonist amlodipine on LVH and urinary albumin excretion in hypertensive patients. Results of EOAM, a multicenter European study [abstract]. J Hypertens 2001;19 (suppl 2):S92.

19. Zanchetti A, Bond MG, Henning N et al. European Lacidipine Study on Atherosclerosis investigators. Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial. Circulation 2002;106:2422-7.

20. Zanchetti A, Agabiti Rosei E, Dal Palu C et al. Verapamil in Hypertension and Atherosclerosis Study (VHAS): results of long-term randomized treatment with either verapamil or chlortalidone on carotid intima-media thickness. J Hypertens 1998;16:1667-76.

21. Simon A, Gariepy J, Moyse D., Levenson Jl. Differential effects of nifedipine and co-amiloride on the progression of early carotid wall changes. Circulation 2001;103:2949-54.

22. Арабидзе Г.Г. Гипертоническая болезнь. В кн.: Руководство по кардиологии под ред. Е.И. Чазова. М.: Медицина, 1992; Т.3. C.147-195.

23. Devereux RB, Reicheck N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977,55:613-8.

24. Goldberg A, Dunlay MC, Sweet CS. Safety and tolerability of losartan potassium, an angiotensin II receptor antagonist, compared with hydrochlorothiazide, atenolol, felodipine ER and ACE inhibitors for the treatment of systemic hypertension. Am J Cardiol 1995;75:793-95.

25. Моисеев В.С., Котовская Ю.В., Кобалава Ж.Д. и др. Клинико-генетические аспекты гипотензивного ответа и обратного развития гипертрофии ЛЖ у больных артериальной гипертонией. Тер арх 2002;74(10):30-7.

26. Cuspidi C, Lonati L, Sampieri L et al. Effects of losartan on blood pressure and LV mass in essential hypertension. High Blood Press.1998;7:75-9.

27. Critchey JA, Chan J, Lappe JT et al. Antihypertensive and antialbuminuric effects and tolerability of losartan potassum compared to felodipine-ER in elderly hypertensive patients. High Blood Press.1998;7:19-20.

28. Bignotti M. Effects of chronic treatment with the AII antagonist losartan on LV anatomy and function and microalbuminuria in hypertensives [abstract]. Eighth European Meeting on Hypertension Milan 13-16 June 1997. P32.

29. Конради А.О., Захаров Д.В., Галявич А.С. Влияние лозартана на показатели вариабельности сердечного ритма и гипертрофию ЛЖ у больных гипертонической болезнью. 1-й конгресс кардиологов СНГ. Тезисы. С. 207.

30. Muller-Brunotte, Eddner M, Malmqvist K et al. Reduced diastolic function in hypertensive left ventricular hypertrophy: improvement by AT1-blocade and beta-blockade [abstract]. J Hypertens 1999;17,3:192.

31. Tedesco M.A. Effects of losartan on hypertension and left ventricular mass. A longterm study [abstract]/ 17th Scientific Meeting of the International Society of Hypertension. Amsterdam 7-11 June 1998. P.1535.

32. Конради А.О., Захаров Д.В., Галявич А.С. Влияние лозартана на показатели вариабельности сердечного ритма и гипертрофию ЛЖ у больных гипертонической болезнью. Тезисы 1-го конгресса Ассоциации кардиологов СНГ 21-23 мая 1997. С. 207.

33. Himmelmann A., Svensson A., et al. Losartan in essential hypertension: effects on BP and left ventricular mass. High Blood Press. 1995;4:242-248.

34. Maiorano G. et al. Evaluation of antihypertensive efficacy of losartan assessed by ABPM, hand grip test and echocardiographic study [abstract]. Glasgow. 23- 27 June 1996. P.1198.

35. Devereux RB, Dahlof B, Gerdts E et al. Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the Losartan intervention for endpoint reduction in hypertension (LIFE) trial. Circulation 2004;110:1456- 62.

36. Wachtell K, Okin PM, Olsen MH, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy and reduction in sudden cardiac death. Circulation 2007, 116: 700-5.

37. Малышева Е.А., Леонова М.В., Прошин А.Ю. и соавт. Влияние амлодипина на массу миокарда ЛЖ и показатели центральной гемодинамики у больных с артериальной гипертонией и атеросклерозом сонных артерий. Клин фармакол тер 1997,6(3):29-32.

38. Agabiti-Rosei E. Evaluation of cardiac effects of antihypertensive agents. J of Cardiovascular Pharmacology.1994;23 Suppl.5:S42-48.

39. Dahlof B, Pennert K, Hansson L. Reversal of left ventricular hypertrophy in hypertensive patients. A metaanalysis of 109 treatment studies. Am J Hypertens 1992;5:95-110.

40. Шляхто E.В., Конради А.О., Захаров Д.В., Рудоманов О.Г. Структурно-функциональные изменения миокарда у больных гипертонической болезнью. Кардиология 1999,(2):49-55.

41. Schulman DS, Flores AR, Tugoen J, Dianzumba S, Reichek N. Antihypertensive treatment in hypertensive patients with normal left ventricular mass is associated with left ventricular remodeling and improved diastolic function. Am J Cardiol 1996;78:56-60.

42. Witkowska M, Spring A, Kosmala et al. The effect of amlodipine on structure and function of the heart and exercise in patients with hypertension. Polskie Archivum medicyny wewnetrznej 1997;40:333-42.

43. Beltman F, Heesen W, Smit A. Two-year follow-up study to evaluate the reduction of left ventricular mass and diastolic function in mild to moderate diastolic hypertensive patients. J Hypertens 1998,16;6:15-9.

44. Мартынов А.И., Степура О.Б., Иванова С.В. и др. Ремоделирование и диастолическая функция ЛЖ сердца у больных с артериальной гипертензией (по материалам XVII-XXI конгрессов Европейского общества кардиологов) Кардиология 2001;(7):67-70.

45. Fagard RH, Staessen JA, Thijs L. Relationships between changes in left ventricular mass and in clinic and ambulatory blood pressure in response to antihypertensive therapy. J Hypertens 1997, 15:1493-502.

46. Linz W, Scholkens ВA, Ganten D: Converting enzyme inhibition specifically prevents the development and Induces regression of cardiac hypertrophy in rats. Clin Exp Hypertens A. 1989;11(7):1325-50.

47. Grandi A.M., Gaudio G., Fachinetti A. et al. Left ventricular diastolic function in lean and obese hypertensives: influence of hyperinsulinaemia and family history of hypertension. XVIII Congress of the European Society of Cardiology. August, 25-29, 1996. Birmingham, UK. CD Conifer Information System. P.1886

48. Franz I-W, Tonnesmann U, Muller JF. Time course of complete regression of left ventricular hypertrophy during long-term antihypertensive therapy with АСЕ inhibitors. 8-th European Meeting on Hypertension. 1997; P. 100

49. Милягин В.А., И.В.Милягина, Н.Ю. Хозяинова. Влияние эналаприла на суточный профиль артериального давления и морфофункциональные показатели сердца у больных с семейной и несемейной формами артериальной гипертонии. Кардиология 1999;39(11):22-6.

50. Malaia I, Tkhostova E, Belousov Y. The influence of angiotensine II resсeptor antagonist irbesartan on endothelial function and diastolic function of left ventricle in patients with mild-to-moderate hypertension [abstract]. J Hypertens 1999;17:254.


For citation:


Tolpygina S.N., Oschepkova E.V., Sergakova L.M., Rogoza A.N. EFFECT OF ANGIOTENSIN-II RECEPTOR ANTAGONIST LOSARTAN AND ITS COMBINATION WITH DIURETICS ON MYOCARDIAL MORPHO-FUNCTIONAL CONDITIONS IN HYPERTENSIVE PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY. Rational Pharmacotherapy in Cardiology. 2008;4(1):67-75. (In Russ.) https://doi.org/10.20996/1819-6446-2008-4-1-67-75

Views: 406


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)