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Losartan improves diastolic ventricular filling of hypertensive patients with diastolic dysfunction
J C Ayoub1, J V Vitola, A Parro
1Medical School of São José do Rio Preto, São Paulo, Brazil.
Insights
Losartan treatment improved diastolic function in hypertensive patients with baseline diastolic dysfunction. This angiotensin II antagonist therapy enhanced left ventricular filling rates and symptoms in this specific subgroup.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension frequently leads to left ventricular (LV) dysfunction.
- Angiotensin II receptor blockers, such as losartan, are used to manage hypertension.
- The specific impact of losartan on LV diastolic function in hypertensive patients requires further elucidation.
Purpose of the Study:
- To investigate the effects of losartan on both systolic and diastolic left ventricular (LV) function in hypertensive patients.
- To assess changes in LV mass, ejection fraction, and diastolic filling parameters before and after 3 months of losartan treatment.
Main Methods:
- A cohort of 19 hypertensive patients received losartan for 3 months.
- Left ventricular (LV) function was evaluated using radionuclide ventriculography (RVG) and echocardiography (ECHO) at baseline and after treatment.
- Key parameters assessed included LV mass, ejection fraction, and LV Peak Filling Rate (PFR).
Main Results:
- Losartan treatment did not significantly alter LV mass or ejection fraction in the overall hypertensive patient group.
- No significant change in LV Peak Filling Rate (PFR) was observed in all patients.
- However, in the subgroup of 12 patients with baseline diastolic dysfunction (PFR < 2.5 EDV/s), losartan significantly improved LV filling (PFR increased from 1.8 to 2.3 EDV/s, p=0.05).
Conclusions:
- Losartan does not significantly impact overall systolic or diastolic LV function in all hypertensive patients.
- Hypertensive patients exhibiting baseline diastolic dysfunction demonstrate significant improvement in LV filling after 3 months of losartan therapy.
- The observed improvement in diastolic function was associated with symptomatic relief.
Abstract:
To evaluate the role of losartan on left ventricular (LV) function of hypertensive patients. Hypertensive patients (n = 19) underwent evaluation of systolic and diastolic LV function, using radionuclide ventriculography (RVG), before and at 3 mo into the treatment with the angiotensin II antagonist losartan. All patients underwent a baseline 12 lead ECG and an echocardiogram (ECHO), which was also repeated at 3 mo into treatment. Results are expressed as mean +/- SEM and statistics were performed using paired t-test. A p value < or = 0.05 was considered significant. Treatment with losartan for 3 mo had no effect on LV mass measured by echo (141+/-5 vs. 139+/-6 g/m2). The LV ejection fraction, measured by RVG, was unchanged by treatment when compared to the baseline study (58+/-2% vs. 57+/-2%, respectivelly, p = 0.49). Considering all patients involved in the study (n = 19), the LV "Peak Filling Rate" (PFR), a parameter of diastolic function measured by RVG, was also unchanged by treatment when compared to baseline (2.5+/-0.2 EDV/s vs. 2.5+/-0.3 EDV/s, respectively, p = 0.9). However the analysis of those patients with evidence of diastolic dysfunction (n = 12) on the baseline RVG (PFR < 2.5 EVD/s), demonstrated significant improvement of LV filling after therapy with losartan (PFR = 1.8+/-0.1 EDV/s vs. 2.3 +/-0.2 EDV/s, respectively, p = 0.05). This change was associated with improvement of symptoms. Our results demonstrated that hypertensive patients with diastolic dysfunction on radionuclide ventriculography have significant improvement of ventricular filling at 3 mo into treatment with losartan.