[Relationship between myocardial modelling and diastolic function in patients with essential hypertension]

Biomarkers and echocardiographic predictors of myocardial dysfunction in patients with hypertension

The study aimed to identify early echocardiographic and circulating biomarkers of heart failure (HF) in hypertensive patients with normal resting echocardiography. Echocardiography at rest and during exercise, and selected biomarkers were assessed in control group, dyspnea group, and HF group. On exercise dyspnea patients had lower early diastolic (E') and systolic (S') mitral annular velocity (12.8 ± 1.0 vs 14.9 ± 3.0 cm/sec and 9.3 ± 2.0 vs 10.9 ± 2.0 cm/sec, respectively), and higher E/E' ratio compared to control group (6.7 ± 1.0 vs 5.9 ± 1.0) (p < 0.05 for all comparisons). The level of N-terminal propeptide of procollagen type III (PIIINP) was significantly higher in dyspnea group than in controls (p = 0.01). Control and dyspnea patients had lower levels of cardiotrophin-1, cystatin C, syndecan-4, and N terminal-probrain natriuretic peptide than HF patients (all p ≤ 0.01). In multivariate analysis PIIINP (unadjusted odds ratio [OR] = 8.2, 95% confidence interval [Cl] 1.7-40.6; p = 0.001; adjusted OR = 8.7; 95%CI: 1.5-48.3; p = 0.001) and E/E' ratio on exercise (unadjusted OR = 1.8, 95%CI: 0.8-4.0; p = 0.033; adjusted OR = 2.0; 95%CI: 0.8-4.8; p = 0.012) were the only factors significantly associated with the presence of dyspnea. PIIINP is the first early biomarker for the HF development in patients with HA and normal resting echocardiography. Exertional echocardiography may indicate patients with incipient HF with preserved ejection fraction.

Echocardiographic changes and treatment goal rates after a 6-month combined treatment with amlodipine and losartan: a validation study in Andean countries (METAL study)

BACKGROUND

The extent to which treatment with amlodipine/losartan may help patients and their doctors from Andean countries to reach their treatment goals remains unknown.

METHODS

We conducted a quasi-experimental, validation study in which patients with primary, uncomplicated hypertension received open-label, fixed combination therapy with amlodipine/losartan 5/50 mg or 5/100 mg according to their baseline blood pressure (BP). The primary outcome was echocardiographic reduction of left ventricular mass (LMV) after 6 months of treatment. Secondary outcomes were changes in BP, uricemia and albuminuria from baseline. We defined patients with adequately controlled hypertension as those with decreases in at least three out of these four variables.

RESULTS

From 109 eligible patients with hypertension, 99 started the protocol (70 under the low-dose combination). Echocardiography indices had mutual correlation and contributed independently to the primary outcome (Cronbach's α index = 0.66). Intention-to-treat analysis showed that 60 patients [60.6%, 95% confidence interval (CI) 50.3-70.3] had reduced LVM. Echocardiographic changes were not associated with dose levels. Favorable changes in BP, uricemia and microabuminuria were seen in 77, 64 and 76 patients respectively. After 6 months there were 64 (95% CI 54-74%) patients with adequately controlled hypertension.

CONCLUSION

Every two of three patients of this sample of Andean countries reached adequate control after 6 months of combined antihypertensive treatment with amlodipine/losartan.