Ventricular and Vascular Remodelling – Effects of the Angiotensin II Receptor Blocker Telmisartan and/or the Angiotensin-Converting Enzyme Inhibitor Ramipril in Hypertensive Patients

Petrovic, J.; Petrovic, D.; Suvajdzic-Vukovic, Nada; Zivanovic, Branislav M.; Dragičević, Josipa; Vasiljević, Zorana; Babic, Rade

doi:10.1177/14732300050330s106

Cited by 44 publications

(28 citation statements)

References 26 publications

(19 reference statements)

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“…Furthermore, the carotid IMT represents structural changes like wall thickening and the formation of atherosclerotic plaques, which are correlated with a greater incidence of atherosclerosis in the coronary circulation and other large arteries [19] . Telmisartan has been shown to cause an insignificant reduction in AI [18] and significant decreases in both BNP [20] and IMT [21] . In the present study, telmisartan-based therapy also tended to decrease the AI and to regress the IMT, consistent with the above-mentioned studies, whereas telmisartan-based therapy did not decrease the BNP.…”

Section: Discussionmentioning

confidence: 99%

Effects of Telmisartan on Arterial Stiffness Assessed by the Cardio-Ankle Vascular Index in Hypertensive Patients

Kinouchi¹,

Ichihara

Sakoda³

et al. 2010

Kidney Blood Press Res

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Background/Aims: This study was conducted to determine the effect of telmisartan on the cardio-ankle vascular index (CAVI), a novel blood pressure (BP)-independent marker for arterial stiffness in hypertensive patients. Methods: One hundred consecutive hypertensive patients were randomly assigned either to a group treated with calcium channel blocker (CCB)-based therapy or a group treated with telmisartan-based therapy. Clinical and biological parameters were then measured before and 12 months after the start of this study. Results: CAVI, the logarithm of urinary albumin excretion, and BP were reduced significantly after telmisartan-based therapy. The decreases in 24-hour diastolic BP and daytime systolic BP associated with telmisartan-based therapy were significantly greater than those associated with CCB-based therapy. Both therapies significantly and similarly decreased the clinical BP, 24-hour systolic BP, daytime diastolic BP and serum levels of low-density lipoprotein cholesterol. No significant differences in the metabolic parameters were observed between the two therapies. Conclusion: Telmisartan-based therapy had beneficial effects on arterial stiffness assessed by CAVI, albuminuria, 24-hour BP and metabolism compared with CCB-based therapy. Since these markers are known to influence the future risk of cardiovascular events, telmisartan could be a useful drug for hypertensive patients.

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Section: Discussionmentioning

confidence: 99%

Effects of Telmisartan on Arterial Stiffness Assessed by the Cardio-Ankle Vascular Index in Hypertensive Patients

Kinouchi¹,

Ichihara

Sakoda³

et al. 2010

Kidney Blood Press Res

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“…One small-scale study has shown that a combination of telmisartan and ramipril produced greater regression of LVH than either monotherapy. 23 A similar observation was made in patients with type 2 diabetes and LVH on dialysis therapy when treated with the ARB losartan, the ACE inhibitor enalapril, or a combination of losartan plus captopril. 24 This hypothesis is being tested in The ONTARGET Trial Programme (Fig.…”

Section: Ontarget Trial Programmementioning

confidence: 83%

Rationale and Design of the Cardiac Magnetic Resonance Imaging Substudy of the ONTARGET Trial Programme

Anderson

2005

J Int Med Res

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Angiotensin-converting enzyme (ACE)inhibitors have been shown to improve cardiovascular disease outcomes in highrisk patients, but evidence for the cardioprotective effects of angiotensin II receptor blockers (ARBs) is less extensive. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and the parallel Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (TRANSCEND) -which together form The ONTARGET Trial Programmeare long-term, large-scale, double-blind, multinational outcome studies with the primary objectives of determining if the combination of the ARB telmisartan 80 mg and the ACE inhibitor ramipril 10 mg is more effective than ramipril 10 mg alone, and if telmisartan is at least as effective as ramipril (in the case of ONTARGET), and if telmisartan is superior to placebo (in the case of TRANSCEND), in providing cardiovascular protection for high-risk patients. A pre-defined substudy is being conducted within The ONTARGET Trial Programme to compare the effects of these agents, alone and in combination, on cardiac structure and function. The substudy overcomes criticisms of many previous studies, which have been performed in small numbers of patients using suboptimal methodology, by evaluating changes in left ventricular structure and function using sophisticated technology provided by magnetic resonance imaging (MRI). Some 300 randomized patients within ONTARGET, recruited from selected centres in Australia, Canada, Germany, Hong Kong, New Zealand and Thailand, will have MRI undertaken at baseline and at 2-year follow-up. As this method of assessing left ventricular dysfunction is somewhat timeconsuming, expensive and complex, and in the light of current interest in the role of B-type natriuretic peptide (BNP) as a simple, inexpensive diagnostic and prognostic tool, the substudy will also examine whether changes in BNP during follow-up correlated with changes in left ventricular dysfunction.

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“…Conduit patency requires the following: the conduit must have antithrombotic properties [13]; intima hypertrophy must not progress in anastomoses between the MPA and the conduit [29], the intima should be covered with neo-endothelial cells [30] and the flexibility and histological form of the valve in the conduit should be maintained [27]. Although Denacol exerts an antithrombotic effect [19], intima hypertrophy in anastomoses has been demonstrated in humans due to delayed healing of the vessel after positioning a small-caliber artificial vascular graft treated with antithrombotics [22]. On the other hand, the autografts used in autologous vascular transplantation have antithrombotic effects derived from self endothelial cells, and such grafts might be highly reliable [29].…”

Section: Discussionmentioning

confidence: 99%

Histological Study of Right Ventricle-Pulmonary Artery Valved Conduit Implantation (RPVC) in Dogs with Pulmonic Stenosis

Saida

Tanaka

Fukushima

et al. 2009

The Journal of Veterinary Medical Science

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ABSTRACT. We examined whether right ventricle-pulmonary artery valved conduit (RPVC) implantation can overcome the disadvantages of current procedures for pulmonic stenosis (PS). We histologically evaluated the feasibility of RPVC using a homograft in PS model dogs. Eight dogs underwent pulmonary artery banding (PAB) and then 12 weeks later were assigned to PAB (n=4) or PAB+RPVC (n=4) groups. Dogs in the PAB group received no treatment throughout the experimental period, whereas the PAB+RPVC group underwent RPVC. At 1 year after PAB, hearts and conduits were explanted from euthanized dogs and histologically evaluated. The ratios (%) of myocardial fibrosis on right ventricle (RV) epicardial, median and endocardial layers were significantly lower in the PAB+RPVC, than in the PAB group. The ratio of myocardial fibrosis on left ventricular (LV) epicardial and endocardial layers were significantly lower in the PAB+RPVC, than in the PAB group. Neo-intimal thickness in the anastomosis areas of the Denacol and PAB+RPVC groups was 42.77  30.19 and 88.30  27.24 m, respectively, with no significant differences between the groups. Calcification and neo-intima hypertrophy were not obvious in the valve area. Immunohistological staining showed that the internal surface of the anastomosis and intermediate areas were positive for endothelial cells. We concluded that RPVC using a bioprosthetic graft can apparently overcome the disadvantages of current procedures for pulmonic stenosis. KEY WORDS: endotherialization, myocardial fibrosis, pulmonary artery banding, pulmonic stenosis, valved conduit.J. Vet. Med. Sci. 71(4): 409-415, 2009 Pulmonic stenosis (PS) is a relatively frequent congenital narrowing of the right ventricular outflow tract that occurs in about 0.1% of all dogs [9]. Strategies for treating severe pulmonic stenosis include transventricular pulmonic dilation [8], closed patch-graft [3,24], open patch-graft [12] and balloon dilation [4,6,14,15] valvuloplasty. Patch-graft valvuloplasty is an effective radical treatment for PS, but it requires a cardiopulmonary bypass to stabilize the circulation, which cannot be performed at many institutions [21]. On the other hand, although balloon dilation valvuloplasty is a popular strategy, the results are inferior in dogs with PS accompanied by dysplasia of the pulmonic annulus and main pulmonary artery to those in dogs with PS alone [6]. Thus, we considered right ventricle (RV)-pulmonary artery valved conduit (RPVC) implantation to overcome the disadvantages of the current procedures. Implantation with the RPVC decreases right ventricular systolic pressure by forming a bypass and the procedure is less invasive because it can be performed under the beating heart. A bioprosthetic valved conduit has been used for RVOT reconstruction in humans [2]. Denacol-treated bioprosthetic implanted conduits are better assimilated and organized with the blood vasculature [19]; they are also thrombo-resistant and do not provoke the immune response [13]. Furthermore, the valve in the condu...

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Ventricular and Vascular Remodelling – Effects of the Angiotensin II Receptor Blocker Telmisartan and/or the Angiotensin-Converting Enzyme Inhibitor Ramipril in Hypertensive Patients

Cited by 44 publications

References 26 publications

Effects of Telmisartan on Arterial Stiffness Assessed by the Cardio-Ankle Vascular Index in Hypertensive Patients

Effects of Telmisartan on Arterial Stiffness Assessed by the Cardio-Ankle Vascular Index in Hypertensive Patients

Rationale and Design of the Cardiac Magnetic Resonance Imaging Substudy of the ONTARGET Trial Programme

Histological Study of Right Ventricle-Pulmonary Artery Valved Conduit Implantation (RPVC) in Dogs with Pulmonic Stenosis

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