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Sequential nephron blockade with diuretics improves diastolic dysfunction in patients with resistant hypertension

Session Poster Session 2

Speaker David Fouassier

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Pharmacotherapy
  • Session type : Poster Session

Authors : D Fouassier (Paris,FR), A Blanchard (Paris,FR), G Bobrie (Paris,FR), P Boutouyrie (Paris,FR), M Azizi (Paris,FR), JS Hulot (Paris,FR)

D Fouassier1 , A Blanchard1 , G Bobrie1 , P Boutouyrie1 , M Azizi1 , JS Hulot1 , 1European Hospital Georges Pompidou - Paris - France ,

Chronic Heart Failure: Pharmacotherapy


Hypertension is one of the major contributors to cardiac diastolic dysfunction.

Different therapeutics strategies have been proposed to control blood pressure (BP) but their independent impact on cardiac function remain undetermined. In patient referred to our center for uncontrolled hypertension, we compared changes in cardiac parameters between two strategies consisting of sequential nephron blockade with intensive diuretics (NBD) or sequential renin angiotensin blockade (RAB).

Purpose: To determine evolution of BNP (brain natriuretic peptides) levels and echocardiographic (TTE) parameters of diastolic dysfunction according to strategies to control BP.

Results:  BNP levels were not significantly different in the two groups at baseline (mean±SD 30.1±37pg/mL in NBD versus 22.6±22.3pg/mL in RAB, p=0.147) but significantly decreased in NBD at week 12 : 20.1±22.7pg/mL versus 55.2±60.4pg/mL in RAB, p<0.0001. At week 12, only 9 (12%) patients in NBD presented BNP levels > 35pg/mL vs. 37 (55%) in RAB (p<0.001). Concordantly, echographic parameters such as left ventricular end-diastolic diameter (mean mean±SD, 49±4mm in NDB and in 52±5mm in RAB, p=0.004) and left atrial area (16.9±3.6cm² in NBD and 19.1±3.7cm² in RAB, p=0.003) improved significantly in NBD group. According to ESC guidelines for evaluation of LV diastolic dysfunction by TTE, the proportions of patients presenting =2 criteria in NBD and RAB group respectively were 31.2% and 19.3% at baseline vs. 3.1% and 32.2% after 12 weeks (p=0.001). In a multivariate analysis, NBD treatment was significantly associated with a decline in BNP levels (p<0.01) even after adjustment on daytime systolic BP lowering, heart rate, renal function, age and gender.

Conclusion: In patients with uncontrolled hypertension, intensive nephron blockade with sequential addition of diuretics improves markers of diastolic dysfunction independently of BP lowering.

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