Network Meta-analysis of oral blood-activating and stasis-removing Chinese patent medicines in treatment of hypertensive left ventricular hypertrophy / 中国中药杂志

This study was designed to assess the clinical efficacy of oral blood-activating and stasis-removing Chinese patent medicines in treating hypertensive left ventricular hypertrophy(LVH) based on network Meta-analysis. The clinical randomized controlled trials(RCTs) concerning the treatment of hypertensive LVH with oral blood-activating and stasis-removing Chinese patent medicines were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library from their inception to September 2021. Two researchers independently completed the literature screening, data extraction, and quality evaluation. The data were then analyzed by RevMan 5.3, Stata 15.1, and ADDIS 1.16.8. Finally, a total of 31 RCTs were included, involving 3 001 patients and four oral blood-activating and stasis-removing Chinese patent medicines. In terms of the alleviation of heart damage, the Chinese patent medicines combined with conventional western medicine groups were superior to the conventional western medicine groups in lo-wering the left ventricular mass index(LVMI). There was no significant difference in LVMI, left ventricular ejection fraction(LVEF), or the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity(E/A) between different Chinese patent medicines combined with conventional western medicine groups. Xinnao Shutong Capsules/Tablets combined with conventional western medicine had the best efficacy in reducing LVMI and elevating LVEF, while Xinkeshu Capsules/Tablets combined with conventional western medicine had the best effect in improving E/A. In the control of blood pressure, when all Chinese patent medicines except for Xinnao Shutong Capsules/Tablets were combined with conventional western medicine, the resulting systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower than those in the conventional western medicine group. Xinkeshu Capsules/Tablets combined with conventional western medicine produced the best effect in reducing SBP and DBP, followed by Xinnao Shutong Capsules/Tablets. In terms of safety, no serious adverse reactions occurred in all trials. The four oral blood-activating and stasis-removing Chinese patent medicines included in this study exhibited obvious advantages in the treatment of hypertensive LVH when they were combined with conventional western medicine, with the best effects observed in the Xinnao Shutong Capsules/Tablets combined with conventional western medicine group. However, due to the limitation of the quantity and quality of the included articles, the conclusion of this study still needs to be verified by more high-quality, multi-center, and large-sample RCTs.

Meta-analysis of clinical efficacy and safety of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in treatment of hypertensive left ventricular hypertrophy / 中国中药杂志

To systematically evaluate the clinical efficacy and safety of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in the treatment of hypertensive left ventricular hypertrophy. China National Knowledge Infrastructure(CNKI), Wanfang, VIP, PubMed, EMbase, Cochrane Library, Ovid and Web of Science databases were searched by computer to retrieve the randomized controlled trials(RCTs) of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in the treatment of hypertensive left ventricular hypertrophy from the establishment of databases to July 2020. After two researchers performed data retrieval, data extraction, and risk assessment of bias, they used RevMan 5.3 software for Meta-analysis. A total of 10 RCTs were included, with a total of 979 patients. Meta-analysis results showed that in terms of interventricular septal thickness(MD=-0.70, 95%CI[-1.15,-0.24], P=0.003), left ventricular posterior wall thickness(MD=-0.81, 95%CI[-1.41,-0.21], P=0.008), left ventricular mass index(MD=-8.75, 95%CI[-17.40,-0.10], P=0.05), systolic blood pressure(MD=-8.97, 95%CI[-13.46,-4.48], P<0.000 1), diastolic blood pressure(MD=-5.87, 95%CI[-8.39,-3.34], P<0.000 01) and left ventricular end-diastolic diameter(MD=-1.73, 95%CI[-2.38,-1.08], P<0.000 01), Compound Danshen Dripping Pills combined with conventional antihypertensive drugs was superior to conventional antihypertensive drugs. In terms of left ventricular ejection fraction(MD=0.41, 95%CI[-0.74, 1.55], P=0.49), there was no statistical difference in treatment between the two groups. Because of the small amount of literatures included in the safety aspect, it is impossible to give an accurate conclusion. The GRADE score showed that the level of evidence was low and extremely low. The results show that the Compound Danshen Dripping Pills combined with conventional antihypertensive drugs may effectively improve the clinical efficacy for hypertensive ventricular hypertrophy, and the safety needs to be further explored. Due to the low quality of the included literatures, more high-quality RCTs are needed for verification.

Effect of Camellia sinensis teas on left ventricular hypertrophy and insulin resistance in dyslipidemic mice

The control of dyslipidemia using plants is an important subject of studies since it has numerous benefits in cardiovascular protection. The objective of this study was to evaluate the effect of three Camellia sinensis L. teas (green, red, and white) on left ventricular hypertrophy and insulin resistance in low-density lipoprotein receptor knockout (LDLr-/-) mice fed a high-fat diet. The LDLr-/- mice were divided into four experimental groups: Group C: standard feed; Group CT: standard feed and three teas, Group HL: high-fat feed; HLT Group: high-fat feed and three teas. The three types of tea (green, red, and white) originated from different processing of the Camellia sinensis L. plant, and were administered associated once a day at a dose of 25 mg/kg by gavage for 60 days. The teas partially prevented hyperlipidemia, the decrease of the serum levels of high-density lipoproteins (HDL), insulin resistance, and increased C-reactive protein (CRP) levels, and completely prevented left ventricular hypertrophy in LDLr -/- mice of the HLT group. In conclusion, the three Camellia sinensis L. teas used to control genetic dyslipidemia associated with a high-fat diet can be used as an auxiliary treatment associated with the control of lipid intake, thus promoting cardiac protection against hyperlipidemia.

Efeitos da administração de eritropoietina na dislipidemia e na hipertrofia ventricular esquerda de camundongos hiperlipidêmicos / Effects of administration of the erythropoietin in dyslipidemia and left ventricular hypertrophy of hyperlipidemic mice

O principal objetivo deste trabalho foi avaliar os efeitos da eritropoietina (EPO) no perfil lipídico e na hipertrofia ventricular esquerda (HVE) de camundongos LDLr-/- alimentados com dieta hiperlipídica, Foram utilizados vinte e quatro camundongos LDLr-/-, machos, 3 meses de idade, equinumericamente divididos em 3 grupos: Grupo S, alimentados com dieta padrão, Grupo HL, alimentados com dieta hiperlipídica (20% de gordura total e 1,25% de colesterol, 0,5 % ácido cólico), Grupo HL+EPO, alimentados com dieta hiperlipídica e tratados com EPO na dose semanal de 200UI/kg via subcutânea, Após 75 dias de experimento foram avaliadas a desenvoltura da HVE e as concentrações séricas de glicose, triglicérides (TG), colesterol total (CT) e de lipoproteínas de baixa densidade (LDL), de muita baixa densidade (VLDL), e de alta densidade (HDL) além da razão entre a massa ventricular esquerda e a massa total do animal: massa ventricular (mg)/massa do animal(g), O protocolo experimental foi aprovado pelo Comitê de Ética Experimental da Universidade sob o número 13A/2010, Ao final do período experimental, os camundongos do grupo HL apresentaram desenvolvimento de HVE com aumento nas concentrações séricas de CT, LDL, VLDL, TG e glicose e redução do HDL, quando comparados com parâmetros dos camundongos do grupo S, O uso da EPO pelo grupo HL+EPO aumentou significativamente (p<0,05) as concentrações séricas do HDL, quando comparados com o grupo HL, e preveniu a HVE, Além disso, reduziu as concentrações de CT, LDL e glicose (p<0,05), Entretanto, a EPO não foi eficiente em impedir a hipertrigliceridemia e tão pouco foi capaz de reduzir as concentrações de VLDL induzidas pela dieta HL, Em conclusão, a EPO apresentou alguns efeitos cardioprotetores, prevenindo a HVE bem como corrigindo algumas das variáveis bioquímicas induzidas pela dieta HL, Estes efeitos podem estar em parte, relacionados ao aumento das concentrações plasmáticas de HDL...

The main purpose of this work was to evaluate the effects of erythropoietin (EPO) on the lipid profile and in left ventricular hypertrophy (LVH) in mice LDLr-/-, fed a high fat diet. Were used twenty-four mice LDLr- / -, male, 3 months old, proportionally divided in 3 groups: S Group, fed with standard diet; HL Group, fed with high fat diet (20% fat total and 1.25% cholesterol, 0.5% cholic acid); HL + EPO Group, fed with high-fat diet and treated with EPO on weekly dose of 200UIkg, subcutaneously. After 75 days of experiment the development of LVH, serum concentrations of glucose, triglycerides (TG), total cholesterol (TC), and low, very low and high density lipoprotein (LDL, VLDL and HDL, respectively) in addition to the left ventricular mass ratio and the total mass of the animal (ventricular mass(mg)/total animal mass(g)) were evaluated. The experimental protocol was approved by the University Ethics Committee of the Experimental Studies under the number 13A/2010. At the end of the trial period, the mice of the HL presented development of LVH with increase in serum concentrations of CT, LDL, VLDL, TG and glucose and a decreased of HDL concentrations, when compared with parameters of mice of the Group S. The use of EPO by HL+EPO group increased serum concentrations of HDL, compared with the HL group (p<0,05) and prevented LVH. In addition, reduced the serum concentrations of TC, LDL, and glucose (p<0,05). However, EPO was not efficient in preventing the hypertriglyceridemia and still, wasn?t able to reduce VLDL concentrations induced by the diet HL. In conclusion, the EPO presented some cardio protective effects, preventing the HVE as well as correcting some of the biochemical variables diet HL-induced. These effects may be, in part, related to increased plasma concentrations of HDL...

Reduction of left ventricular hypertrophy by sirolimus in kidney transplant recipients: a nonrandomized clinical trial

Persistence of left ventricular hypertrophy [LVH] in renal transplant recipients is associated with unfavorable outcomes. Calcineurin-inhibitor [CNI] nephrotoxicity is a major cause of morbidity and mortality after kidney transplantation. In this study we compared sirolimus [SRL] with calcineurin-inhibitor as primary immunosuppressants for the attenuation of left ventricular hypertrophy in renal transplantation recipients. In this prospective cohort study done in Shariati Hospital in 2010, we evaluated the effects of sirolimus and CNI on LVH of 55 renal transplant recipients. The cases [19] received sirolimus while the controls [36] received CNI while being matched for age and duration of transplantation. Data regarding blood pressure [BP], hemoglobin, serum creatinine, uric acid and lipid concentrations were assessed and changes in left ventricular [LV] mass were evaluated by echocardiography over a one-year follow-up. Left ventricular mass significantly decreased [P=0.0001] in the SRL group but blood pressure did not differ between the two groups. LV mass and LV mass index both decreased significantly [P<0.05] but the difference was not associated with changes in BP. The difference in interventricular septal thickness at end diastole [IVSD] and posterior wall diameter [PWD] were significant [P<0.05] in the SRL group but the difference in end diastolic diameter [EDD] was not significant. Conversion from CNI to SRL-based immunosuppressive therapy in RTRs is safe and SRL may decrease LVH. SRL seems to be safe and improve renal function without cardiac compromise in kidney transplant recipients

Effects of spironolactone in spontaneously hypertensive adult rats subjected to high salt intake

OBJECTIVE: To evaluate the effect of spironolactone on ventricular stiffness in spontaneously hypertensive adult rats subjected to high salt intake. INTRODUCTION: High salt intake leads to cardiac hypertrophy, collagen accumulation and diastolic dysfunction. These effects are partially mediated by cardiac activation of the renin-angiotensin-aldosterone system. METHODS: Male spontaneously hypertensive rats (SHRs, 32 weeks) received drinking water (SHR), a 1 percent NaCl solution (SHR-Salt), or a 1 percent NaCl solution with a daily subcutaneous injection of spironolactone (80 mg.kg-1) (SHRSalt- S). Age-matched normotensive Wistar rats were used as a control. Eight weeks later, the animals were anesthetized and catheterized to evaluate left ventricular and arterial blood pressure. After cardiac arrest, a doublelumen catheter was inserted into the left ventricle through the aorta to obtain in situ left ventricular pressurevolume curves. RESULTS: The blood pressures of all the SHR groups were similar to each other but were different from the normotensive controls (Wistar = 109±2; SHR = 118±2; SHR-Salt = 117±2; SHR-Salt-S = 116±2 mmHg; P<0.05). The cardiac hypertrophy observed in the SHR was enhanced by salt overload and abated by spironolactone (Wistar = 2.90±0.06; SHR = 3.44±0.07; SHR-Salt = 3.68±0.07; SHR-Salt-S = 3.46±0.05 mg/g; P<0.05). Myocardial relaxation, as evaluated by left ventricular dP/dt, was impaired by salt overload and improved by spironolactone (Wistar = -3698±92; SHR = -3729±125; SHR-Salt = -3342±80; SHR-Salt-S = -3647±104 mmHg/s; P<0.05). Ventricular stiffness was not altered by salt overload, but spironolactone treatment reduced the ventricular stiffness to levels observed in the normotensive controls (Wistar = 1.40±0.04; SHR = 1.60±0.05; SHR-Salt = 1.67±0.12; SHR-Salt- S = 1.45±0.03 mmHg/ml; P<0.05). CONCLUSION: Spironolactone reduces left ventricular hypertrophy secondary to high salt intake and ventricular stiffness in adult SHRs.

Parathyroid hormone accelerates decompensation following left ventricular hypertrophy

Parathyroid hormone (PTH) treatment was previously shown to improve cardiac function after myocardial infarction by enhancing neovascularization and cell survival. In this study, pressure overload-induced left ventricular hypertrophy (LVH) was induced in mice by transverse aortic banding (TAB) for 2 weeks. We subsequently evaluated the effects of a 2-week treatment with PTH or saline on compensated LVH. After another 4 weeks, the hearts of the mice were analyzed by echocardiography, histology, and molecular biology. Echocardiography showed that hearts of the PTH-treated mice have more severe failing phenotypes than the saline-treated mice following TAB with a greater reduction in fractional shortening and left ventricular posterior wall thickness and with a greater increase in left ventricular internal dimension. Increases in the heart weight to body weight ratio and lung weight to body weight ratio following TAB were significantly exacerbated in PTH-treated mice compared to saline-treated mice. Molecular markers for heart failure, fibrosis, and angiogenesis were also altered in accordance with more severe heart failure in the PTH-treated mice compared to the saline-treated mice following TAB. In addition, the PTH-treated hearts were manifested with increased fibrosis accompanied by an enhanced SMAD2 phosphorylation. These data suggest that the PTH treatment may accelerate the process of decompensation of LV, leading to heart failure.

Anti-hypertensive drugs have different effects on ventricular hypertrophy regression: [review]

OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca++ channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca++ channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective â1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.

Combinación de un inhibidor de la enzima convertidora de la angiotensina con un antagonista del calcio versus la monoterapia con el IECA: eficacia terapéutica en hipertensión arterial esencial y regresión de la hipertrofia cardíaca / Combination of a converting enzyme inhibitor (ACEI) with a calcium antagonist versus monotherapy with an ACEI: therapeutic efficacy in essential hypertension and regression of ventricular hypertrophy

Objetivo: Evaluar la eficacia y la tolerancia, así como su acción sobre la regresión de la hipertrofia ventricular izquierda, de la combinación de benazepril más amlodipina (B + A) versus la monoterapia con benazepril (B). Material y métodos: Se incluyeron 33 hipertensos esenciales. Durante 6 meses de tratamiento, 18 de ellos recibieron B + A (9 varones, 55 ± 2 años) y los 15 restantes recibieron B (10 varones, 49 ± 2 años). Se realizó una presurometría (MAPA) al comienzo y a los 3 y a los 6 meses de tratamiento. En un subgrupo de 23 pacientes se calculó la masa ventricular izquierda (MVI) y el índice de MVI (IMVI) al inicio y al final del tratamiento. Resultados: A los 3 meses de tratamiento, los valores de la presión arterial (PA) fueron significativamente menores (p < 0,05) en los pacientes tratados con B + A que con B (24 horas: 123 ± 1,7 / 77 ± 1,8 versus 132 ± 1,5 / 85 ± 1,6 mm Hg; día: 127 ± 1,9 / 81 ± 1,8 versus 137 ± 1,8 / 91 ± 1,9 mm Hg; noche: 115 ± 2,0 / 68 ± 2,1 versus 122 ± 2,0 / 76 ± 1,7 mm Hg). Esto se logró con una dosis menor y hubo mejor tolerancia. En el grupo B + A, la MVI y el IMVI disminuyeron de 225,3 ± 47,4 g y 125,5 ± 19,3 g/m², a 187,2 ± 45,1 g y 104,7 ± 27,2 g/m2 (p < 0,05), mientras que en el grupo B la disminución no resultó estadísticamente significativa. Al finalizar el tratamiento, sólo en los pacientes tratados con B + A se observó una correlación positiva entre el descenso de la PAS y la MVI (r = 0,56, p < 0,025) y el IMVI (IMVI: r = 0,60; p < 0,01). Conclusión: La combinación B + A mostró una reducción de la PA más precoz. Se requirió una dosis menor y se obtuvo mejor tolerancia clínica que con B solo. En relación con la MVI y el IMVI, estos parámetros disminuyeron en forma significativa sólo en B + A.

Remodelação miocárdica após infarto agudo do miocárdio experimental em ratos: efeito do bloqueio do sistema renina angiotensina aldosterona / Myocardial remodeling after experimental acute myocardial infarction in rats: effect of renin-angiotensin-aldosterone system blockade

OBJETIVO: Verificar a ação do lisinopril e do losartan sobre a remodelação miocárdica no infarto experimental em ratos. MÉTODOS: Ratos machos Wistar foram submetidos a infarto e tratados com lisinopril 20 mg/kg/dia (LIS, n=13) ou losartan 20 mg/kg/dia (LOS, n=11), ou mantidos sem tratamento (NT, n=11), por três meses e os resultados comparados com grupo controle (CONT, n=11) de ratos sem infarto. Após a eutanásia, o ventrículo esquerdo foi separado e pesado. Foram medidas a área seccional dos miócitos (AC), fração de colágeno intersticial (CVF) e a hidroxiprolina (HOP) miocárdica. As variáveis foram comparadas pela ANOVA de uma via, para nível de significância de p<0,05. RESULTADOS: O infarto agudo promoveu a hipertrofia do ventrículo esquerdo e os tratamentos com lisinopril e losartam preveniram a hipertrofia quantificada pelo peso do ventrículo esquerdo (LOS=1,06± 0,12g, LIS=0,97±0,18g, NT=1,26±0,17g, CONT=1,02± 0,09g; p<0,05), pelo peso de ventrículo esquerdo corrigido pelo peso corporal VE/PC (LOS=2,37±0,21mg/g, LIS=2,41± 0,38mg/g,NT=2,82±0,37mg/g, CONT=2,27± 0,15mg/g) e pela medida da AC do ventrículo esquerdo (LOS=210±39µ², LIS=217±35µ², NT=256±35µ², CONT= 158±06 µ²; p<0,05). O CVF foi significantemente maior no ventrículo esquerdo do grupo infartado e houve prevenção do aumento com os tratamentos (LOS=1,16±0,4 por cento, LIS=1,27± 0,5 por cento, NT=1,8± 0,4 por cento, CONT=0,7±0,5 por cento). A HOP foi maior no grupo infartado (NT=6,91±2,98mg/g vs. CONT=2,81±1,21mg/g) e não alterou com o tratamento. CONCLUSÃO: A remodelação miocárdica pós-infarto é caracterizada por aumento da massa ventricular remanescente e aumento de colágeno intersticial. O bloqueador da enzima conversora da angiotensina e o antagonista seletivo AT1 da angiotensina II previnem a hipertrofia do miócito e a fibrose intersticial.

Losartan versus enalapril en la reducción de la hipertrofia ventricular izquierda secundaria a hipertensión arterial sistémica / Losartan versus Enalapril in the reduction of left ventricular hypertrophy secondary to systemic arterial hypertension

Objetivo: Comparar losartan y enalapril en la reducción de la hipertrofia ventricular izquierda. Material y métodos: Estudio clínico, experimental, longitudinal, prospectivo, comparativo, controlado, de pacientes con hipertensión arterial sistémica moderada y datos ecocardiográficos de hipertrofia ventricular izquierda, aleatorizados para manejo durante 6 meses con losartan 100 mg diarios o enalapril 20 mg diarios. La disminución del índice de masa ventricular izquierda, se evaluó mediante ecocardiograma basal y a los 6 meses. Análisis estadístico: t de Student, coeficiente de Spearman y correlación de Pearson. Resultados: 85 pacientes completaron el estudio (43 en el grupo de losartan y 42 en el grupo de enalapril). A los 6 meses de manejo, las cifras de presión arterial y el índice de masa ventricular izquierda disminuyeron significativamente tanto con losartan como con enalapril (p= .0000001 y .00001 respectivamente), sin diferencia significativa en la comparación inter-grupal. Encontramos correlación entre la disminución de las cifras de presión arterial diastólica y media (pero no la sistólica) y la disminución del índice de masa ventricular izquierda en ambos grupos. Conclusiones: Ambos medicamentos son igual de efectivos para controlar la hipertensión arterial sistémica y revertir la hipertrofia ventricular, con modificación a corto plazo del patrón geométrico.

Objective: To compare losartan and enalapril on reduction of left ventricular hypertrophy. Material and methods: Longitudinal, prospective, comparative, controlled study, of patients with moderate systemic arterial hypertension and echocardiographically proven left ventricular hypertrophy, randomized for treatment during six months with losartan 100 mg daily or enalapril 20 mg daily. The reduction of left ventricular mass index, was evaluated by echocardiogram basal and to six months. Statistical analysis: Student's t, Spearman and Pearson correlation coefficients. Results: 85 patients finished the study (43 in the losartan group and 42 in the enalapril group). After six months of treatment, the blood pressure values and the left ventricular mass index decreased in losartan and enalapril (p= .0000001 y .00001 respectively), without significative difference in the intergrupal comparative. We found correlation between diastolic and media blood pressure reduction (but not for systolic) and the decrease in left ventricular mass index in both groups. Conclusions: Both drugs were equally effective for control systemic arterial hypertension and produced a significant reduction of left ventricular hypertrophy, with modification of geometrical pattern to short time.

effect of combination therapy on regression of left ventricular hypertrophy in cases with hypertension

Up to this date, it is well shown that several antihypertensive drugs have different regressive effect on left ventricular hypertrophy [LVH]. However, there are different studies regarding the effect of antihypertensive combination therapies on regression of LVH. In this study, 2 different combinations ACE-I plus calcium channel blocker and ACE-I plus diuretic were compared in cases with hypertension whose BPs were not controlled by ACE-I alone. Forty patients with mild to moderate hypertension were included in this study. The treatment was continued for 6 months in the Faculty of Medicine at Ege University, Turkey, between January and December 2003. Adequate response with lisinopril 20mg/daily failed to be achieved in all patients. Patients divided into 2 groups. There were no differences between the groups in patients' age, blood pressure [BP] and other clinical and laboratory range. First group patients received lisinopril 20mg + nifedipine GITS 30mg and second group patients received lisinopril 20mg + hydrochlorothiazide 25mg. The treatment was continued for 6 months. Blood pressure were measured every 2 weeks, echocardiographic findings, and blood and urinary analysis were performed before and at the end of treatment. Systolic and diastolic BP decreased significantly in both groups and no significant difference regarding BP was found between the 2 groups. Left ventricular mass index also decreased significantly in both groups. However, in the first group left ventricular mass index decreased more compared to the second group. The effect of combination therapies with angiotensin converting enzyme inhibitor [ACE-I] plus diuretic and ACE-I plus calcium channel blocker on systolic and diastolic BP are similar. However, when LVH is present, regressive effect of the combination of ACE-I plus calcium channel blocker is superior to the combination of ACE-I plus diuretic

The cardiopulmonary reflexes of spontaneously hypertensive rats are normalized after regression of left ventricular hypertrophy and hypertension

Cardiopulmonary reflexes are activated via changes in cardiac filling pressure (volume-sensitive reflex) and chemical stimulation (chemosensitive reflex). The sensitivity of the cardiopulmonary reflexes to these stimuli is impaired in the spontaneously hypertensive rat (SHR) and other models of hypertension and is thought to be associated with cardiac hypertrophy. The present study investigated whether the sensitivity of the cardiopulmonary reflexes in SHR is restored when cardiac hypertrophy and hypertension are reduced by enalapril treatment. Untreated SHR and WKY rats were fed a normal diet. Another groups of rats were treated with enalapril (10 mg kg-1 day-1, mixed in the diet; SHRE or WKYE) for one month. After treatment, the volume-sensitive reflex was evaluated in each group by determining the decrease in magnitude of the efferent renal sympathetic nerve activity (RSNA) produced by acute isotonic saline volume expansion. Chemoreflex sensitivity was evaluated by examining the bradycardia response elicited by phenyldiguanide administration. Cardiac hypertrophy was determined from the left ventricular/body weight (LV/BW) ratio. Volume expansion produced an attenuated renal sympathoinhibitory response in SHR as compared to WKY rats. As compared to the levels observed in normotensive WKY rats, however, enalapril treatment restored the volume expansion-induced decrease in RSNA in SHRE. SHR with established hypertension had a higher LV/BW ratio (45 percent) as compared to normotensive WKY rats. With enalapril treatment, the LV/BW ratio was reduced to 19 percent in SHRE. Finally, the reflex-induced bradycardia response produced by phenyldiguanide was significantly attenuated in SHR compared to WKY rats. Unlike the effects on the volume reflex, the sensitivity of the cardiac chemosensitive reflex to phenyldiguanide was not restored by enalapril treatment in SHRE. Taken together, these results indicate that the impairment of the volume-sensitive, but not the chemosensitive, reflex can be restored by treatment of SHR with enalapril. It is possible that by augmenting the gain of the volume-sensitive reflex control of RSNA, enalapril contributed to the reversal of cardiac hypertrophy and normalization of arterial blood pressure in SHR.

Hipertrofia ventricular izquierda regresión con lisinopril vs. amlodipino

Objetivo: la hipertrofia ventricular izquierda secundaria a hipertensión conlleva enfermedad coronaria, arritmia, falla cardíaca y muerte súbita. Se ha reportado regresión con el tratamiento farmacológico. Nosotros cuantificamos la respuesta a inhibidores ECA y calcioantagonistas, comparando su eficacia. Diseño:experimento clínico controlado, aleatorizado, ciego. Marco de referencia: Hospital Universitario San Juan de Dios de Bogotá, servicio de consulta externa, programa riesgos cardiovasculares. Pacientes: se seleccionaron los pacientes teniendo como criterios; hipertensión arterial (HTA) de recientes diagnóstico y sin medicación, sin enfermedad cardiovascular concomitante, no obesos ni atletas, entre octubre 1994 y junio 1997. Intervención: asignación aleatoria a tratamiento con lisinopril y amlodipino. Medición: ecocardiografía bidimensional al inicio y seis meses despúes de tratamiento farmacológico. Resultados: de 35 pacientes seleccionados, 30 finalizaron el estudio, los grupos fueron homogéneos, en cuanto a edad, peso, talla y cifras de presión arterial. Encontramos una prevalencia de 30 por ciento para hipertrofia y una regresión de 15.64 gr/m² en el grupo de lisinopril (10.6 por ciento) y 4.6 gr.m²(3.65 por ciento) en el grupo de amlodipino, diferencias no significativas. Control de presión arterial adecuada en ambos grupos de 150/104 al inicio a 140/84 en el grupo A y 159/105 a 139/84 en el grupo B, eficacia comparable. Conclusión: aunque hubo control adecuado de la presión arterial y regresión de la hipertrofia en más de 60 por ciento de los pacientes en ambos grupos, las diferencias no fueron estadísticamente significativas

Reversäo da hipertrofia ventricular esquerda na terapêutica da hipertensäo arterial: fato ou ficçäo? / Reversal of the left ventricular hypertrophy in the therapeutics of hypertension: fact or fiction?

Nesta revisão, são discutidas as possibilidades de reversão da hipertrofia ventricular esquerda associada à hipertensão arterial. São apresentados a epidemiologia e os mecanismos fisiopatológicos da hipertrofia ventricular, sua importância como fator de risco cardiovascular, o efeito do tratamento farmacológico e não-farmacológico sobre sua evolução e as conseqüências da reversão sobre a função ventricular e sobre o prognóstico dos pacientes hipertensos.