Effects of valsartan on left ventricular diastolic function in patients with mild or moderate essential hypertension: comparison with enalapril

Objective This study compares the effects of an AT(1) angiotensin II recept or antagonist (valsartan) with those of an ACE inhibitor (enalapril) on lef t ventricular (LV) diastolic function in patients with mild or moderate ess ential hypertension and no evidence of LV hypertrophy at echocardiography. Methods A total of 24 patients (10 men, mean age 47 +/- 8 years) underwent radionuclide ambulatory monitoring (Vest) of LV function at rest and during upright bicycle exercise testing before and after two 4-week treatment per iods with valsartan (80-160 mg/day orally) and enalapril (20-40 mg/day oral ly) according to a double-blind, crossover randomization scheme. Results In the overall population no differences between the two treatments were found in LV peak filling rate (PFR) either at rest or at peak exercis e. In a subgroup analysis it was found that baseline PFR was normal (= 2.5 EDV/sec) in 12 patients (subgroup A) and impaired (< 2.5 EDV/sec) in the re maining 12 (subgroup B). In both subgroups. valsartan and enalapril induced a significant and comparable reduction of systolic and diastolic blood pre ssure. In subgroup A, valsartan and enalapril did not induce significant ch anges in PFR. In subgroup B, valsartan increased PFR both at rest (from 2.0 +/- 0.3 to 2.4 +/- 0.3 EDV/sec, P < 0.01) and at peak exercise (from 4.1 /- 1.1 to 4.4 +/- 1.0 EDV/s, P < 0.05), whereas enalapril did not change PF R either at rest (2.0 +/- 0.4 EDV/s, P < 0.01 versus valsartan) or at peak exercise (3.7 +/- 1.1 EDV/sec, P< 0.05 versus valsartan). Conclusions Valsartan-induced renin-angiotensin system blockade is able to improve LV filling in patients with mild or moderate essential hypertension and impaired diastolic function. These findings support the hypothesis of a contribution of the renin-angiotensin system in the control of LV diastol ic function in these patients. J Hypertens 1999, 17:1759-1766 (C) Lippincot t Williams & Wilkins.