Related Experiment Videos
[Prospects of endothelial dysfunction reversion in patients with congestive heart failure]
Insights
Enalapril and losartan improved endothelial function in patients with congestive cardiac insufficiency. Enalapril showed a greater ability than losartan to reverse endothelial dysfunction, particularly in those with ischemic heart disease.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Congestive cardiac insufficiency is associated with endothelial dysfunction.
- Impaired endothelial function contributes to vasoconstriction and reduced blood flow.
- Assessing the impact of specific medications on endothelial function is crucial for treatment.
Purpose of the Study:
- To evaluate the effects of enalapril (angiotensin-converting enzyme inhibitor) and losartan (AT1 receptor blocker) on shoulder artery endothelial function.
- To compare the efficacy of enalapril and losartan in patients with congestive cardiac insufficiency and stable effort angina.
- To determine if these drugs can reverse endothelial dysfunction.
Main Methods:
- A 12-week randomized trial involving 96 patients with congestive cardiac insufficiency.
- Patients received basic therapy plus either enalapril, losartan, or long-acting nitrates/digoxin/aspirin/furosemide.
- Endothelial function was assessed using high-resolution echography and dopplerography before and after temporary shoulder artery occlusion and sublingual nitroglycerin administration.
Main Results:
- Both enalapril and losartan prevented vasoconstriction in the shoulder artery after occlusion.
- Flow-induced vasodilation was more pronounced in the enalapril group.
- Losartan showed a trend towards increasing shoulder artery diameter; enalapril and losartan improved endothelium-dependent vasodilation.
- Enalapril demonstrated a stronger effect than losartan in reversing endothelial dysfunction.
Conclusions:
- Enalapril and losartan can improve endothelial function in patients with congestive cardiac insufficiency.
- Enalapril appears to be more effective than losartan in reversing endothelial dysfunction, especially in ischemic heart disease.
- These findings support the use of ACE inhibitors and ARBs in managing endothelial dysfunction in cardiac insufficiency.
Abstract:
The aim of the study was to investigate the effect of angiotensin-converting enzyme inhibitor enalapril and non-peptide blocker of AT1 receptors losartan on endothelial function of the shoulder artery in patients with congestive cardiac insufficiency. The examination covered 96 patients (mean age 46.71 +/- 4.13) with stable effort angina (functional class II-III) and circulatory insufficiency (NYHA functional class II-III) having end-diastolic left-ventricular volume > 160 ml, left ventricular ejection fraction < 35%, sinus rhythm, cardiothoracal index > 0.55 units. Patients with fibrillar tachyarrhythmia, high grade blocks, pacemaker migration, artificial pacemaker, myocardial infarction were not included in the trial. The patients were randomized into 3 groups 32 patients each. In addition to basic therapy patients of group 1 received long-acting nitrates, digoxin, aspirin and furosemide; group 2--enalapril in daily dose 10 mg; group 3--losartan in daily dose 25 mg. A course of treatment lasted 12 weeks. Endothelial function was assessed by high resolution echography, dopplerography performed before and after temporary occlusion of the shoulder artery and sublingual nitroglycerin. In patients with cardiac insufficiency, accelerated blood flow in the shoulder artery after its temporary occlusion promoted realization of the vasoconstrictory reaction. This was verified as endothelial dysfunction. In the course of the treatment all the patients achieved insignificant increase of the shoulder artery initial diameter. After sublingual intake of nitroglycerin vasodilation was also insignificant. 12-week enalapril and losartan prevented vasoconstriction in the shoulder artery in response to quicker circulation following arterial occlusion. However, higher maximal flow speed did not correspond to the increment in the artery diameter after the occlusion in any group. The flow-induced vasodilation was more pronounced in the enalapril group. Losartan group had a trend to an increase in the inner diameter of the shoulder artery. It is shown that enalapril and losartan in congestive cardiac insufficiency improves endothelium-dependent vasodilation caused by nitroglycerin. Enalapril demonstrated stronger ability than losartan to reverse endothelial dysfunction in patients with cardiac insufficiency resultant from ischemic heart disease.