Effects of Aliskiren on Blood Pressure and Myocardial Function Assessed by Global Longitudinal Strain in Patients with Arterial Hypertension and Diastolic Dysfunction

Abstract

OBJECTIVE: To evaluate the effects of aliskiren on blood pressure and myocardial function assessed by global longitudinal strain in patients with uncontrolled arterial hypertension. PATIENTS AND METHODS: Forty-fi ve patients were included in the study (29 males, 16 females, mean age 58.7 ± 12.4 years) with BP > 140/90 mmHg despite treatment with combined antihypertensive therapy and echocardiographic data for diastolic dysfunction: Е/Е'ratio ≤ 8, Е/А ratio < 0.8, deceleration time (DT) > 200 msec. Aliskiren (2 х 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 trans-mitral blood fl ow was performed at months 1, 6, 12. RESULTS: The baseline systolic and diastolic blood pressures scores were 153.4 ± 14.4/99.2 ± 6.7 mmHg and 157.6 ± 12.5/97.3 ± 8.2 mmHg for males and females, respectively. The systolic and diastolic values at 1 month were 131.7 ± 7.4/83.6 ± 5.2 mmHg for males and 132.4 ± 5.3/81.8 ± 6.9 mmHg for females (р < 0.05 vs. baseline). The baseline Е/Е' was 6.5 ± 0.9, Е/А -0.6 ± 001, DT -258 ± 32.7 msec. These indicators at month 12 were as follows: Е/Е' -7.0 ± 0.64, Е/А -0.7 ± 0.05, DT -239 ± 16.5 msec, р = NS. Baseline global longitudinal strain in males was -10.4 ± 0.7% and -11.0 ± 0.9% in females and at month 12 -16.3 ± 0.9% and -17.5 ± 0.7% for males and females, respectively, р < 0.05. For the period of follow-up no adverse effects due to aliskiren treatment were registered. CONCLUSIONS: Adding aliskiren to combined antihypertensive therapy leads to signifi cant improvement of hypertension control and myocardial function assessed by global longitudinal strain.

Long-term effects of a renin inhibitor versus a thiazide diuretic on arterial stiffness and left ventricular diastolic function in elderly hypertensive patients

“…We observed an increased ejection fraction, but no significant reduction of E/A in elderly hypertensive patients with aliskiren treatment. Similarly, recent studies demonstrated no effect of adding aliskiren to other types of antihypertensive drugs on E/A in uncontrolled hypertensive patients (21). The discrepancy between animal and human studies may be attributable to a much higher dose (mg/kg) of aliskiren used in animals than that administered in humans.…”

Cardiac and Vascular Target Organ Damage in Pediatric Hypertension

“…For patients with increased LVM, we typically re-assess LVM on an annual basis until normalization of LVM is noted. Studies in adults have demonstrated that treatment of hypertension results in significant improvements in diastolic function ( 83 ) and systolic strain ( 84 ). Improvement in cardiac function with treatment have also been seen in youth as increased shortening fraction was demonstrated in a pediatric patients with chronic kidney disease who underwent intensive BP treatment ( 85 ).…”