Objective: To evaluate the effect of valsartan, eprosartan or losartan on LVH and NT-proBNP levels in patients with hypertension and preserved ejection fraction Design and method: This is randomized, prospective and double-blind study involved 154 hypertensive patients (56,5% men; mean age 53,6 ± 0,5 years) with concentric LVH remodeling (LV mass > 115 g/m2 and 95 g/m2 in men and women, respectively), which were eligible criterions to randomize to receive medication into three groups: valsartan (n = 48), eprosartan (n = 54), losartan (n = 52) over a follow-up period of 24 months. Echocardiography, ambulatory blood pressure monitoring and NT-proBNP assessments were performed at baseline and after 24 months treatment. Results: Despite similar effects on ambulatory blood pressure levels, significant differences on LV mass index were found between valsartan, eprosartan and losartan treatment (mean decrease 27.0 g/m2 vs 35 g/m2 and 24.0 g/m2, respectively, p < 0,001), and there was positive correlation of changes in ambulatory systolic blood pressure with LV mass index (r = 0,5; p < 0,001). Eprosartan-based therapy induced a greater reduction in NT-proBNP levels (-45,6%, p < 0,001) from baseline than in the valsartan (-28,9%, p < 0,01) and losartan group (- 26,5%,, p < 0,01). Conclusions: The findings of this study showed that all three agents progressively reduced LVH, but the reduction was significantly greater in the eprosartan group. Additionally, eprosartan was associated with a greater reduction of NT-proBNP levels.
The treatment of resistant hypertension remains difficult despite the progress made in the development of antihypertensive remedies. In this context, renal artery denervation has been shown to be effective and safe in clinical trials published over the past three years. The complex ablation of the main renal arteries and their small branches with a diameter over 4 mm obtained with second-generation catheters has demonstrated its superiority in reducing blood pressure compared to first-generation catheters, which allowed ablation to be performed only in the main branches of the renal arteries. The present paper presents part of the research conducted in the Department of Hypertension, its purpose being to evaluate the effectiveness of renal denervation in patients with resistant hypertension.
Objective:Fueled by a global pandemic of cardiovascular diseases, hypertension (HT) remains the leading cause of early mortality in the world. Blood pressure variability (BPV) is considered to be in relation to a worse prognosis. Disrupted blood pressure variability (BPV) and insulin resistance (IR) often coexist as” satellite conditions”. This association potentiate the target organ damages (TOD). Microalbuminuria (MA) is an important biomarker of extra-cardiac damage, and subsequently, hypertension and/or carbohydrate metabolism’s alteration can lead to abnormalities in urinary albumin excretion. Each of these conditions can increase adverse hazards per se or via promoting hypertension or extracardiac injuries.Aim: To determine the correlation between disrupted BPV, level of carbohydrate metabolism’s alteration and microalbuminuria.Design and method:101 patients with essential hypertension (49,5% men; mean age 50,11 ± 0,79 years, mean BMI 24.4 ± 0.5 kg/m2; eGRF > 60 ml/min/1.73m2) with excessive BPV (systolic BP> 15 mmHg; diastolic BP > 14 mmHg), IR and microalbuminuria. Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE), HOMA-IR and Ma were performed. The BPV was referred to the software analysis of ABPM data. To define IR was used The Homeostasis Model Assessment of insulin resistance (HOMAIR) levels; threshold values was considered > 2. MA was appreciated according to the current guidelines (30–300 mg/24 h). Correlation analysis was performed using Pearson’s test. The correlation coefficient was considered weak at < 0.3, medium-0.3–0.7 and strong> 0.7–1.0. Statistical significance was appreciated at a P-value < 0.05 and highly significant at a P-value < 0.001.Results:Excessive BPV, HOMA-IR and MA indices demonstrate a statistically significant correlation (p < 0.001). Systolic BPV demonstrated a particularly strong relationship with higher HOMA-IR levels and MA (p < 0.05) (Table 1).Conclusions: In hypertensive patients, disrupted BP variability strongly correlates with microalbuminuria and carbohydrate metabolism abnormality. This association appears to have a particularly strong relationship with systolic BPV and correlates with higher HOMA-IR levels.
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