Background: The epidemiological studies have confirmed that half of patients with heart failure indeed have preserved ejection fraction. Hypertension is one of the common causes of diastolic dysfunction and heart failure. Early treatment is important in preventing irreversibile structural alterations and systolic dysfunction.
Objective: To compare the effects of an angiotensin receptor blockers - in a based regimen on valsartan, eprosartan or losartan on diastolic function and N-terminal pro-brain natriuretic peptide levels in heart failure with preserved left ventricular ejection fraction.
Methodology: In this study were included 165 hypertensive patients with a systolic blood pressure ≥140 mmHg, a left ventricular ejection fraction ≥50% and diastolic dysfunction. Echocardiographic indices derived from Doppler mitral inflow velocities, combined with tissue Doppler imaging, where E1/A1 ratio was (0,37±0,02) and E/A ratio was (0,61±0,01), confirmed the diastolic dysfunction with impaired relaxation profile. The plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were ≥125 pg/ml for all patients in the study. All patients were randomly selected for treatment with valsartan, eprosartan or losartan for a period of 30 months. At baseline and at the end of the 30 months of treatment, echocardiography, ambulatory blood pressure monitoring and NT-proBNP assessments were performed.
Results: Although ambulatory blood pressure levels, echocardiographic diastolic parameters and plasma levels of NT-proBNP did not differ significantly between groups at baseline, after treatment period, such measurements as systolic blood pressure levels were lower (-28,5%, p<0,001) in eprosartan group, versus valsartan and losartan (-25,8% and -23,9%, respectively, p<0,01). E/E1 ratio was also lower in eprosartan group (-30%, p<0,001) than valsartan or losartan groups. The NT-proBNP levels were decresed in all study groups, but while in eprosartan group the levels were -45,6%, p<0,001, in valsartan or losartan groups the levels were similar: -28,9% and -26,5%, respectively, p<0,01. We noticed a medium negative relatioship between E1/A1 ratio and average mean systolic blood pressure (r=-0,48, p<0,01).
Conclusion: At the end of the study, after 30 months of therapy with valsartan, eprosartan or losartan, a significant improvement was noted in all diastolic function variables, in patients with preserved left ventricular ejection fraction. Eprosartan treatment resulted in a more significant reduction in levels of NT-proBNP and systolic blood pressure. At the end of follow-up period, the proportion of patients achieving normalization of blood pressure was higher with eprosartan versus valsartan or losartan (96% versus 85,4% or 79,2%, p<0,0001, x2=46,1), this difference did achieve statistical significance.