Olmesartan ameliorates myocardial function independent of blood pressure control in patients with mild-to-moderate hypertension

Abstract

Angiotensin II receptor blockers (ARBs) are suggested to be protective against myocardial hypertrophy and fibrosis, although such beneficial effects remain to be elucidated in the human heart. The aim of the present study was to examine the effect of a novel ARB, olmesartan, on myocardial function of the left ventricle in patients with mildto-moderate hypertension. We investigated 10 patients (6 men and 4 women, 62 +/- 7 years of age) who were stable with a single regimen of amlodipine, which was switched to olmesartan. Before and 8 months after changing medications, patients underwent echocardiographic examination and blood sampling, including measurement of the plasma high-sensitivity C-reactive protein (hsCRP) level. Peak velocities at the mitral annulus were determined by tissue Doppler imaging and used as measures of myocardial function. Olmesartan did not significantly alter blood pressure (BP) (systolic BP, 122 +/- 12 to 121 +/- 8 mmHg, P = 0.9; diastolic BP, 79 +/- 6 to 75 +/- 4 mmHg, P = 0.06) or parameters of global left ventricular systolic and diastolic function. Tissue Doppler imaging, however, revealed significant increases in the systolic (8.2 +/- 1.3 to 8.9 +/- 1.1 cm/s, P < 0.01) and early diastolic (6.7 +/- 0.9 to 7.6 +/- 1.0 cm/s, P = 0.02) velocities at the mitral annulus. This was associated with decreases in the left ventricular mass index (83 +/- 15 to 73 +/- 19 g/m2, P = 0.09) and hsCRP (683 +/- 555 to 655 +/- 450 ng/ml, P = 0.07). In conclusion, olmesartan improves myocardial function independent of BP reduction in hypertensive patients. Attenuated inflammatory changes as well as myocardial hypertrophy may play an important role.

Neuronal nitric oxide synthase inhibition improves diastolic function and reduces oxidative stress in ovariectomized mRen2.Lewis rats

“…Taken together with our findings, these data implicate a direct role of cardiac NOS in the preservation of cardiac structure and diastolic function. Our data corroborate clinical and experimental studies which show cardiac functional improvements associated with decreased oxidative stress following blockade of the renin angiotensin system that are independent of blood pressure 38–40…”

Association between High-Sensitivity C-Reactive Protein and Left Ventricular Diastolic Function Assessed by Echocardiography in Patients with Cardiovascular Risk Factors

“…A recent clinical study (Futai et al 2009) reported that an angiotensin II receptor blocker, which is one of the renin-angiotensin system blockers (RASBs), improved LV diastolic dysfunction and decreased hsCRP in hypertensive patients. In the present study, hsCRP did not differ between patients (0.22 ± 0.26 mg/dL) with RASBs and those (0.21 ± 0.28 mg/dL) without RASBs.…”

The Effects of Antihypertensive Agents in Metabolic Syndrome – Benefits Beyond Blood Pressure Control

“…Patients with chronic kidney disease (CKD), who have higher baseline levels of inflammation than control subjects with normal renal function, displayed significant reductions in hsCRP and brachial BP with olmesartan medoxomil treatment [107]. In a small study of 10 patients with mild-to-moderate hypertension, olmesartan medoxomil did not reduce BP significantly, but did produce significant reductions in hsCRP and appeared to improve myocardial function independent of BP lowering [19]. In another study, hsCRP levels significantly dropped in hypertensive patients who were treated with olmesartan for 6 month [102].…”

“…As a class, ARBs are known to have anti-inflammatory properties, which may contribute to their pharmacologic effects. Biomarker studies in hypertensive patients have demonstrated the effects of ARBs on inflammatory and other biomarkers [7,14], including CAP [15,16], hsCRP [14,[17][18][19], adiponectin [20], cystatin [21,22], HOMA-IR [23][24][25], procollagen [26][27][28], TNF- [29][30][31], and IL-6 [32][33][34].…”