Effect of dual blockade of renin-angiotensin system on TGFbeta1 and left ventricular structure and function in...

Area of Science:

• Cardiology
• Pharmacology
• Hypertension Research

Background:

• Hypertension (HT) is a major risk factor for cardiovascular disease.
• Left ventricular hypertrophy (LVH) is a common complication of HT.
• The renin-angiotensin system (RAS) plays a key role in HT pathophysiology and cardiac remodeling.

Purpose of the Study:

• To evaluate the effects of losartan and ramipril, alone and in combination, on left ventricular mass (LVM) and cardiac fibrosis markers in hypertensive patients.
• To compare the efficacy of dual RAS blockade versus monotherapy in reducing cardiac remodeling markers.

Main Methods:

• A randomized, double-blind, three-arm trial involving 57 patients with stage 1 and 2 essential hypertension.
• Patients received losartan (50 mg/day), ramipril (5 mg/day), or a combination for 24 weeks.
• Measurements included LVM, transforming growth factor beta1 (TGFbeta1), procollagen type I (PIP), and procollagen type III (PIIIP) before and after treatment.

Main Results:

• All treatment groups showed significant reductions in blood pressure, TGFbeta1, PIP, PIIIP, LVM, and LVM/h(2.7).
• The combination therapy group exhibited significantly greater reductions in TGFbeta1 and LVM/h(2.7) compared to monotherapy groups, particularly in patients with LVH.
• No significant differences in blood pressure reduction were observed between the groups.

Conclusions:

• Dual blockade of the renin-angiotensin system with losartan and ramipril provides an additional cardioprotective effect in hypertensive patients.
• Combination therapy is more effective in reducing cardiac remodeling markers like TGFbeta1 and LVM compared to monotherapy.
• These findings support the benefit of dual RAS blockade in managing hypertensive patients with cardiac involvement.