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

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

Myocardial functional status in patients with arterial hypertension and hyperaldosteronism: orthogonal electrocardiography assessment

Aim. To study orthogonal electrocardiography (ECG) parameters among arterial hypertension (AH) patients, in regard to renin-angiotensin-aldosterone system (RAAS) functional status. Material and methods. The study included 41 AH patients, mean age 45±2.8 years, and control group of 41 healthy individuals, mean age 41±7 years. Plasma aldosterone concentration (PAC) and plasma rennin activity (PRA) were measured at rest and after 4-hour walking. In all participants, 12-lead ECG and orthogonal ECG were registered, assessing left ventricular hypertrophy (LVH) criteria: Sokolow-Lyon criterion, Cornell index, Rx+Sz summary index, and repolarization acceleration vector module (G). Results were compared with echocardiography (EchCG) signs of LVH. Results. All patients had low-renin AH with various PAC levels. Three groups were identified: Group I (n=16), with adrenal cortex aldosteroma; Group II (n=12), with adrenal cortex hyperplasia; Group III (n=13), with normal PAC and no adrenal pathology. Comparing to Groups II and III, Group I had higher levels of systolic and diastolic blood pressure (BP), as well as more pronounced hyperaldosteronemia and hypokaliemia (p<0.05). Mean Cornell index in Group III was significantly lower than in Group I: 1.6±0.2 vs 2.5±0.2 mV, respectively. G index in Group III (71±9 ms) was significantly greater than in Groups I (35±5 ms) or II (47±6 ms). Inter-group differences for other parameters were not observed. Conclusion. Patients with adrenal cortex aldosteroma had significantly higher BP levels, more pronounced hyperaldosteronemia, hypokaliemia, and ECG signs of LVH, comparing to Groups II or III