To compare the effects of an angiotensin receptor blockers-based regimen with valsartan, eprosartan or losartan on LVH and NT-proBNP levels in hypertensives with preserved LV systolic function.Design and method:
Clinical study/design: 154 hypertensive patients (56,5% of men; mean age 53,6 ± 0,5 years) with concentric LVH, DD and preserved ejection fraction (EF > 50%) and symptomatic HF II-III NYHA. Functional class of HF was evaluated on the basis of a six minute walk test (6MWT). All patients were randomly assigned to treatment with Losartan (L-gr; n = 54, mean dose = 125,7 ± 0,8 mg ± mg/daily), Valsartan (V-gr; n = 48, mean dose = 240 ± 0,7 mg/daily) or Eprosartan (E-gr; n = 52, mean dose = 900 ± 0.9 mg/daily). Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE), 6MWT, and serum NT-proBNP activity were performed at baseline and after 12-, and 24- months period of treatment. The normal cut-off value for NT-pro BNP level in patients < 75 yrs old was considered <125 pg/ml. LV mass index (LVMI)> 95 g/m2 in women and >115 g/m2 in men identified LV hypertrophy. Relative wall thickness (RWT >0.42) help to categorize geometry of LV remodeling to concentric LVH. Parameters used in assessment of diastolic function and LV filling pressure were: left atrium (LA) volum index, isovolumetric relaxation time (IRVT), deceleration time (DT), E/A ratio, E/e’ (averaged) ratio.Results:
At baseline, group did not differ statistically with respect to age, clinic and hemodynamic status (Table1). The baseline ambulatory blood pressure levels were similar among the groups and reductions were as well comparable (Table 2). At the running-up, the LVMI were comparable in all groups but during the follow-up period, this reduction was more significant in group randomized to eprosartan (-35 g/m2, p < 0,001) (Tabel 3). Also, the NT-proBNP levels have decreased greater in the eprosartan group (-45,6%, p < 0,001), while in the valsartan and losartan group the reduction was comparable((-39,06% and 40,46%, respectively, p < 0,01) (Table 4).Conclusions:
The findings of the study showed that all three agents progressively reduced LVH, but this reduction was significantly greater in the eprosartan group. Additionally, eprosartan was associated with a greater reduction of NT-proBNP levels.