The Effect of Enalapril and Telmisartan on Clinical and Biochemical Indices of Sympathetic Activity in Hypertensive Patients

Lewandowski, Jacek; Abramczyk, Piotr; Dobosiewicz, Anna; Bidiuk, Joanna; Siński, Maciej; Gaciong, Zbigniew

doi:10.1080/10641960802279132

Cited by 18 publications

(10 citation statements)

References 41 publications

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“…This reflects a greater complexity of RRi series for patients from the CAD-group. Due to the inhibition of angiotensin II functions along with the consequent attenuation of vasoconstriction and sympathetic activity 38 ACE inhibitors lead to significant recovery of HRV indices, as observed through linear methods, which implies an improvement in the autonomic modulation of HR and a satisfactory prognosis 39 .…”

Section: Discussionmentioning

confidence: 99%

The relationship between cardiac autonomic function and clinical and angiographic characteristics in patients with coronary artery disease

Kunz¹,

Souza²,

Takahashi³

et al. 2011

Rev. bras. fisioter.

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Background: A reduction in heart rate variability (HRV) is considered an important indicator of autonomic dysfunction. Objectives: The aims of this study were to evaluate the presence of autonomic dysfunction measured by HRV in patients with coronary artery disease (CAD) and to compare them with normal subjects. Methods: A sample of 52 men (mean age 54±5.39 years) was allocated into three groups: obstructive CAD ≥50% (CAD+ n=18), obstructive CAD <50%, (CAD-n=17) and apparently healthy controls (CG n=17). Heart rate (HR) was measured at rest using a Polar®S810i for 15 min. HRV was analyzed via Shannon entropy (SE) and symbolic analysis (0V and 2ULV), which relate to sympathetic and vagal predominance, respectively. Statistical analysis included the Kruskal-Wallis test and multivariate analysis (p<0.05). Results: The CAD+ group presented lower SE and 2ULV% values and higher 0V% compared to CADand control groups (p<0.05). In the multivariate analysis, the presence of the clinical characteristics such as myocardial infarction and revascularization in the CAD+ group lead to a lower SE and higher 0V compared to the CAD-group. The use of angiotensin converting enzymes led to a higher SE in the CAD-group compared to the CAD+ (p<0.05). Conclusions: In uncomplicated CAD+ patients the patterns of HRV have a lower complexity, a greater sympathetic modulation and a lower parasympathetic modulation compared to CAD-and control groups in supine resting conditions. These results indicate that autonomic heart dysfunction is related to the degree of coronary occlusion and cardiac compromise.

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Section: Discussionmentioning

confidence: 99%

The relationship between cardiac autonomic function and clinical and angiographic characteristics in patients with coronary artery disease

Kunz¹,

Souza²,

Takahashi³

et al. 2011

Rev. bras. fisioter.

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“…[6][7][8][9][10] There are several experimental evidences of antifibrillatory and antifibrotic effects of ACEI/ARBs probably by downregulating MAPK or ERK1/ERK2 expression and reducing collagenase activity. 53 A recent animal experiment 54 indicated that telmisartan inhibit sympathetic nervous system activity in obesity-induced hypertensive rats. In the research performed byLi et al, 50 it was found that dogs with ventricular tachypacing-induced congestive heart failure had a substrate for AF maintenance and the MAPK expression were increased, and treatment with enalapril significantly reduced these changes and attenuated the effects of congestive heart failure on atrial conduction, atrial fibrosis, and mean AF duration.…”

Section: Benefits and Possible Mechanisms Of Ras Blockade Therapy On mentioning

confidence: 99%

Renin–Angiotensin System Inhibitors Prevent the Recurrence of Atrial Fibrillation

Han

Zhang

Sun³

et al. 2013

Journal of Cardiovascular Pharmacology

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“…15 Telmisartan versus enalapril Thirteen trials involving 1682 patients compared telmisartan with enalapril. 5,[15][16][17][18][19][20][21][22][23][24][25][26] There was a greater reduction in both DBP and SBP with the use of telmisartan as compared with enalapril. Therapeutic response rates of DBP and SBP favored telmisartan (RR 1.15, 95% confidence interval (CI) 1.05-1.26; RR 1.18, 95% CI 1.02-1.38, respectively).…”

Section: Resultsmentioning

confidence: 99%

Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials

Zou

Yuan

et al. 2008

J Hum Hypertens

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Telmisartan and angiotensin-converting enzyme inhibitors (ACEIs) are both effective and widely used antihypertensive drugs targeting renin-angiotensinaldosterone system. The study aimed to estimate the efficacy and tolerability of telmisartan in comparison with different ACEIs as monotherapy in the treatment of hypertension. Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. A random-effect model was used to account for heterogeneity among trials. Twenty-eight randomized controlled trials involving 5157 patients were ultimately identified out of 721 studies. Telmisartan had a greater diastolic blood pressure (DBP) reduction than enalapril (weighted mean difference (WMD) 1.82, 95% confidence interval (CI) 0.66-2.99), ramipril (WMD 3.09, 95% CI 1.94-4.25) and perindopril (WMD 1.48, 95% CI 0.33-2.62). Telmisartan also showed a greater DBP response rate than enalapril (relative risk (RR) 1.15, 95% CI 1.05-1.26), ramipril (RR 1.34, 95% CI 1.11-1.61) and perindopril (RR 1.22, 95% CI 1.05-1.41). There was no statistical difference in DBP reduction or therapeutic response rate between telmisartan and lisinopril (WMD À0.30, 95% CI À0.65 to 0.05; RR 0.99, 95% CI 0.80-1.23, respectively). Telmisartan had fewer drug-related adverse events than enalapril (RR 0.57, 95% CI 0.44-0.74), ramipril (RR 0.44, 95% CI 0.26-0.75), lisinopril (RR 0.70, 95% CI 0.56-0.89) and perindopril (RR 0.52, 95% CI 0.28-0.98). The meta-analysis indicates that telmisartan provides a superior BP control to ACEIs (enalapril, ramipril and perindopril) and has fewer drug-related adverse events and better tolerability in hypertensive patients.

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The Effect of Enalapril and Telmisartan on Clinical and Biochemical Indices of Sympathetic Activity in Hypertensive Patients

Abstract: Despite similar BP control, telmisartan attenuated autonomic balance more effectively than enalapril.

Cited by 18 publications

References 41 publications

The relationship between cardiac autonomic function and clinical and angiographic characteristics in patients with coronary artery disease

The relationship between cardiac autonomic function and clinical and angiographic characteristics in patients with coronary artery disease

Renin–Angiotensin System Inhibitors Prevent the Recurrence of Atrial Fibrillation

Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials

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