Pioglitazone improves left ventricular diastolic function in patients with essential hypertension

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Hypertension commonly leads to left ventricular (LV) hypertrophy and diastolic dysfunction.
• Insulin resistance is a key factor modifying these cardiac changes.
• The study investigated if treating insulin resistance could reverse cardiac alterations in hypertensive individuals.

Purpose of the Study:

• To assess the impact of primary insulin resistance treatment on cardiac changes in hypertensive patients.
• To determine if pioglitazone, an insulin sensitizer, could reverse LV hypertrophy and diastolic dysfunction.
• To explore the relationship between improved insulin sensitivity and cardiac function parameters.

Main Methods:

• 30 patients with essential hypertension were treated with pioglitazone (30 mg/day) for six months.
• Echocardiography measured LV mass index, early diastolic to atrial filling (E/A) ratio, and E-wave deceleration time (DcT).
• Insulin sensitivity was assessed using the steady-state plasma glucose (SSPG) method, alongside adiponectin and matrix metalloproteinase (MMP)-2 measurements.

Main Results:

• Pioglitazone significantly improved diastolic function, increasing E/A and decreasing DcT, without altering LV mass index.
• Improvements in diastolic properties were more pronounced in patients with a marked decrease in SSPG.
• Treatment elevated plasma adiponectin and MMP-2 levels, with increases positively correlated.

Conclusions:

• Pioglitazone enhances LV diastolic function in hypertensive patients by improving insulin resistance.
• The beneficial effects on diastolic function are linked to increased adiponectin and MMP-2 levels.
• LV mass did not regress, indicating pioglitazone's primary impact is on diastolic function, not hypertrophy reversal.