Effects of renin-angiotensin system blockers on left ventricular hypertrophy and biochemical markers of collagen balance in patients with hypertensive hypertrophy

• Published in: Terapevtic̆eskii arhiv Vol. 81; no. 5; pp. 64 - 70
• Main Authors: Ovchinnikov, A G, Serbul, V M, Ageev, F T
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) "Consilium Medicum" Publishing house 01-01-2009
• Subjects: ace inhibitor; Angiotensin II Type 1 Receptor Blockers - administration & dosage; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; Benzimidazoles - administration & dosage; Benzimidazoles - therapeutic use; Biomarkers - blood; blocker of angiotensin receptors; Blood Pressure - drug effects; Collagen - blood; Dose-Response Relationship, Drug; Drug Therapy, Combination; Enalapril - administration & dosage; Enalapril - therapeutic use; Female; Humans; Hypertension - blood; Hypertension - complications; Hypertension - drug therapy; Hypertrophy, Left Ventricular - blood; Hypertrophy, Left Ventricular - drug therapy; Hypertrophy, Left Ventricular - etiology; inhibitor of matrix metalloprotease-1; left ventricular hypertrophy; Male; matrix metalloprotease-1; Matrix Metalloproteinase 1 - blood; Middle Aged; Renin-Angiotensin System - drug effects; Tetrazoles - administration & dosage; Tetrazoles - therapeutic use; Tissue Inhibitor of Metalloproteinase-1 - blood; Treatment Outcome
• ISSN: 0040-3660; 2309-5342

To evaluate the effect of ACE inhibitor enalapril, AR blocker candesartan and their combination on left ventricular hypertrophy (LVH) and content of biochemical markers of collagen balance in patients with hypertensive LV hypertrophy. MATERIAL AND METHODS. A total of 66 patients with arterial hypertension with LV hypertrophy were divided into two groups. Group 1 (n = 33) received candesartan (8-16 mg/day), group 2 (n = 33) received enalapril (10-20 mg/day). In effective hypotensive response to the initial treatment, it was continued for 6 months. If in two months of monotherapy the effect was unsatisfactory, the other drug was added. At baseline and upon 6 months of treatment all the patients were examined for myocardial mass index (MMI), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of matrix metalloproteinase-1 (THMP-1) in the blood.
In effective initial treatment with candesartan 6-month treatment lowered LV MMI by 13.9%, while in enalapril group--only by 1.5%. In addition of the second drug in ineffective initial therapy the reduction was 5.1%. THMP-1 did not change during the trial.
In patients with hypertensive LVH candesartan more effectively treated LVH. The addition of the second RAS blocker in insufficient efficacy of the initial one significantly reduces LV MMI. A significant antifibrotic effect was achieved only in case of simultaneous use of two RAS blockers.