Effects of an angiotensin II receptor antagonist on urinary albumin excretion, left ventricular mass, and systolic and diastolic blood pressures in essential hypertension

Circulating, locally generated angiotensin II plays a key role in cardiac, renal, and vascular structural changes. The aim of this study was to invest igate the effects of losartan, an angiotensin II receptor (type AT,) antago nist, on cardiac and renal function and lipid profile in patients with esse ntial hypertension. Forty patients (29 women, 11 men), mean age 51.9 +/- 10 .2 years (range, 34 to 72 years), with mild-to-moderate essential hypertens ion were treated with losartan for 12 weeks. Before and after treatment, 24 -hour urinary albumin excretion, serum electrolytes, serum Lipid profile, a nd creatinine clearance were measured. In addition, systolic and diastolic blood pressures and left ventricular mass were determined by Doppler and M- mode echocardiography. Radionuclide ventriculography was performed to asses s ejection fraction. Mean arterial pressure decreased significantly from 12 1.9 mm Hg at baseline to 96.6 mm Hg after 12 weeks of treatment (P = 0.0001 ). Low-density Lipoprotein/ high-density Lipoprotein cholesterol ratio decr eased significantly from 3.5 +/- 1.8 to 2.9 +/- 0.8 (P = 0.03). A significa nt reduction was found in left ventricular mass (from 186.9 +/- 41.3 g to 1 79.7 +/- 41.8 g) (P = 0.0001). No significant change in urinary albumin exc retion was found after 12 weeks. We did not identify any serious side effec ts and did not find any significant change in serum electrolytes or systoli c cardiac function. Although the decrease in creatinine clearance was stati stically significant (P = 0.002), the mean creatinine clearance was within the normal range (96.01 +/- 16.3 mL/min); this change was not clinically si gnificant. The effect of losartan on diastolic cardiac function was not cle ar. Results of this study suggest that losartan is an effective, safe agent in the treatment of essential hypertension and has beneficial effects on l eft ventricular mass and serum lipid profile.