Comparative effects of chronic ACE inhibition and AT1 receptor blocked losartan on cardiac hypertrophy and renal function in hypertensive patients

被引:33
作者
De Rosa, ML [1 ]
Cardace, P [1 ]
Rossi, M [1 ]
Baiano, A [1 ]
de Cristofaro, A [1 ]
机构
[1] Univ Naples Federico II, Fac Med, Dept Cardiol Internal Med & Geriatry, Naples, Italy
关键词
losartan; renin-angiotensin system; left ventricular mass; renal function;
D O I
10.1038/sj.jhh.1001305
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
The present study describes the effects of losartan and the angiotensin-converting enzyme inhibitor enalapril on blood pressure, echocardiographically calculated left ventricular mass, renal function evaluated by glomerular filtration rate and quality of life. The renin-angiotensin-aldosterone system is of importance for cardiovascular growth. There Is substantial experimental documentation in animals that the angiotensin II antagonist, losartan, decreases the cardiac hypertrophy response caused by elevated arterial pressure as well as Intravascular volume overload. However, data in humans is scarce. This is a 3-year, randomised, double-blind study with parallel group design in 50 patients with essential hypertension. The results show that both drugs reduced blood pressure equally effectively, and also left ventricular mass (P < 0.001). After 3 years of treatment glomerular filtration rate significantly increased with losartan (P < 0.005). Serum uric acid fell modestly although significantly, dose-dependent in losartan patients compared with an increase in enalapril patients. A fall in serum potassium from the pre-study period was observed in all patients. There was no difference between treatments in terms of patient satisfaction on quality of life. Both drugs have relatively similar hormonal and haemodynamic effect, with an excellent tolerability profile; they appear to induce comparable blood pressure falls in hypertensive patients in particular, therapy based on specific Ang II blockade may offer advantages in high risk hypertensives if left ventricular hypertrophy is present. Both enalapril and losartan, in improving the renal function attenuating the intrarenal effects of angiotensin II, might be able to reverse the pathophysiology of essential hypertensive kidney disease, and should be first-choice drugs in the treatment of essential hypertension.
引用
收藏
页码:133 / 140
页数:8
相关论文
共 26 条
[1]  
Armitage P., 1971, STAT METHODS MED RES
[2]   EFFECTS OF THE NONPEPTIDE ANGIOTENSIN-II RECEPTOR ANTAGONIST DUP 753 ON BLOOD-PRESSURE AND RENAL FUNCTIONS IN SPONTANEOUSLY HYPERTENSIVE PH DOGS [J].
BOVEE, KC ;
WONG, PC ;
TIMMERMANS, PBMWM ;
THOOLEN, MJMC .
AMERICAN JOURNAL OF HYPERTENSION, 1991, 4 (04) :S327-S333
[3]   ACE INHIBITORS IN RENAL-DISEASE [J].
BRUNNER, HR ;
COHEN, JJ ;
PIRSON, Y ;
VANES, LA ;
REMUZZI, G ;
MADIAS, NE ;
ZUSMAN, RM ;
KOCH, KM ;
BAGGIO, B ;
WINEARLS, CG ;
JAEGER, P ;
VANYPERSELE, C .
KIDNEY INTERNATIONAL, 1992, 42 (02) :463-479
[4]   SALT-DEPENDENT RENAL EFFECTS OF AN ANGIOTENSIN-II ANTAGONIST IN HEALTHY-SUBJECTS [J].
BURNIER, M ;
RUTSCHMANN, B ;
NUSSBERGER, J ;
VERSAGGI, J ;
SHAHINFAR, S ;
WAEBER, B ;
BRUNNER, HR .
HYPERTENSION, 1993, 22 (03) :339-347
[5]   ORAL-ADMINISTRATION OF DUP-753, A SPECIFIC ANGIOTENSIN-II RECEPTOR ANTAGONIST, TO NORMAL-MALE VOLUNTEERS - INHIBITION OF PRESSOR-RESPONSE TO EXOGENOUS ANGIOTENSIN-I AND ANGIOTENSIN-II [J].
CHRISTEN, Y ;
WAEBER, B ;
NUSSBERGER, J ;
PORCHET, M ;
BORLAND, RM ;
LEE, RJ ;
MAGGON, K ;
SHUM, L ;
TIMMERMANS, PBMWM ;
BRUNNER, HR .
CIRCULATION, 1991, 83 (04) :1333-1342
[6]   REVERSAL OF LEFT-VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS - A METAANALYSIS OF 109 TREATMENT STUDIES [J].
DAHLOF, B ;
PENNERT, K ;
HANSSON, L .
AMERICAN JOURNAL OF HYPERTENSION, 1992, 5 (02) :95-110
[7]  
DAHLOF B, 1992, BLOOD PRESSURE S6, V1, P1
[8]   ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-VENTRICULAR HYPERTROPHY - COMPARISON TO NECROPSY FINDINGS [J].
DEVEREUX, RB ;
ALONSO, DR ;
LUTAS, EM ;
GOTTLIEB, GJ ;
CAMPO, E ;
SACHS, I ;
REICHEK, N .
AMERICAN JOURNAL OF CARDIOLOGY, 1986, 57 (06) :450-458
[9]  
DEVEREUX RB, 1990, HYPERTENSION PATHOPH, P1479
[10]  
DZAU VJ, 1993, J HYPERTENS, V11, pS13