Angiotensin II Antagonism and the Heart: Valsartan in Left Ventricular Hypertrophy

Abstract

Left ventricular hypertrophy (LVH) represents an independent risk factor for cardiovascular morbidity and mortality, and normalization of left ventricular mass has become a desirable goal of antihypertensive treatment. In a randomized, double-blind study the angiotensin II (AT₁ receptor) antagonist valsartan (Diovan^®; 80 mg/160 mg q.d.) was compared with the beta-blocker atenolol (50 mg/100 mg q.d.) over 8 months in predominantly previously untreated patients with essential hypertension and LVH. Sixty-nine patients were randomized, of whom 58 were evaluated with echocardiographic data. After 8 months of treatment in the atenolol group [n = 8 with additional hydrochlorothiazide (HCTZ)], initial blood pressure was reduced from 160/103 to 147/92 mm Hg (p < 0.0001), and in the valsartan group (n = 9 with additional HCTZ) blood pressure decreased from 163/101 to 146/90 mm Hg (p < 0.0001). Left ventricular mass index decreased from 127 to 117 g/m² in the atenolol group and from 127 to 106 g/m² in the valsartan group. Long-term treatment with valsartan resulted in a significant reduction of LVH in patients with essential hypertension.

The Relationship in Hypertensive Patients Endothelin Levels, Echocardiographic Findings and Valsartan

“…In another study, left ventricular mass was demonstrated to decrease by 14% with captopril treatment, 30% with enalapril and 12% with lisinopril (20). Another study showed that valsartan reduced cardiac hypertrophy (19). We observed a 19.9% decrease in LVH with three months of valsartan and/or hydrochlorothiazide treatment.…”

“…On the other hand, some antihypertansive agents have no such an effect as expected although they effectively reduce the blood pressure (16). In a study, LVH was shown to be revresed more than 10% in the first eigth weeks, 25% in the first year and more than 40% in the third year (19). In another study, left ventricular mass was demonstrated to decrease by 14% with captopril treatment, 30% with enalapril and 12% with lisinopril (20).…”

Antihypertensive efficacy of olmesartan compared with other antihypertensive drugs

“…There is clinical evidence suggesting that A II receptor blockers may confer cardioprotective effects superior to those conferred by other classes of antihypertensives, while achieving similar decreases in blood pressure (BP). 2 A more persistent improvement in renal haemodynamics has also been demonstrated for A II receptor blockers in comparison with ACE inhibitors, despite equivalent BP reduction. 3 This could be important in cases of dia- betic nephropathy and chronic renal failure.…”

Haemodynamic effects of AT1 inhibition and Ca2+-channel blockade in hypertensive patients during isometric stress

“…5 Valsartan is a selective antagonist of type 1 ATII receptors (AT1) which is effective in reducing arterial pressure 6 and in improving myocardial compliance. 7,8 Some data demonstrates its efficacy in chronic heart failure. 9 Interesting data is emerging about the prevention of and the fight against the atherosclerotic process.…”