Does Aliskiren Influence the Changes of Global Longitudinal Strain in Patients with Diastolic Dysfunction?

Abstract

Abstract:The aim of our study was to investigate the effects of Aliskiren on the blood pressure values as well as on the myocardial function, assessed by GLS (global longitudinal strain) in patients with uncontrolled АH (arterial hypertension) and diastolic dysfunction. Forty five nondiabetic patients (29 men and 16 women, mean age 58.7 ± 12.4 years) with BP (blood pressure) > 140/90 mm Hg despite of combined antihypertensive therapy (diuretic, calcium channel blockers, beta-blockers) were evaluated. All of them had echocardiographic data for diastolic dysfunction: Е/Е' ratio ≤ 8, Е/А ratio < 0.8, DT (deceleration time) > 200 ms. Aliskiren 2 × 150 mg per day was added to the previous therapy. The follow-up period was 1 year, including monthly clinical visits. Echocardiographic assessment of the left ventricular function by longitudinal strain and Doppler analysis of the transmitral blood flow was performed at months 1, 6 and 12. The baseline mean measurements of systolic and diastolic BP values showed (153.4 ± 14.4)/(99.2 ± 6.7) mmHg for males and (157.6 ± 12.5)/(97.3 ± 8.2) mmHg for females. The systolic and diastolic BP values at the end of the 1st month were (131.7 ± 7.4)/(83.6 ± 5.2) mmHg in men and (132.4 ± 5.3)/(81.8 ± 6.9) mmHg in women (Р < 0.05, compared to the initial BP values). The baseline ratio of Е/Е' was found to be 6.5 ± 0.9, Е/А-0.6 ± 0.01 and DT-258 ± 32.7 ms. The values of these parameters at month 12 were as follows: Е/Е'-7.0 ± 0.64, Е/А-0.7 ± 0.05, DT-239 ± 16.5 ms (Р = NS). Baseline global longitudinal strain in men was -10.4 ± 0.7% and -11.0 ± 0.9% in women, whereas GLS at month 12 showed values of: (-16.3 ± 0.9%) and (-17.5 ± 0.7%) for males and females respectively (Р < 0.05). During the whole period of treatment with Aliskiren and follow-up no adverse effects were registered. Aliskiren, added to a combined antihypertensive therapy (without RAAS-renin-angiotensin-aldosterone system blocker) in patients with uncontrolled AH and diastolic dysfunction provides not only a better BP control, but also a significant improvement of the myocardial function, assessed by global longitudinal strain. The 12 months treatment with Aliskiren was safe and well tolerated.