Doubling the ACE inhibitor dose, adding losartan, or bicycle training significantly improved radial artery diameter increase by 83%, 92%, and 95% respectively in CHF patients (P<0.05).
RCT (n=60)
Does doubling ACE inhibitor dose, adding an angiotensin II antagonist, or exercise training improve flow-mediated vasodilation in patients with congestive heart failure?
Enhancing renin-angiotensin system blockade or adding exercise training significantly improves endothelial function, as measured by flow-mediated vasodilation, in patients with heart failure.
p-value: p=<0.05
Congestive heart failure (CHF) is associated with an impaired flow-mediated vasodilation that reflects an impaired endothelial function. Limited information is available, however, on whether and to what extent this impairment is improved by pharmacological or nonpharmacological treatment. We measured radial artery diameter and blood flow by an echo-tracking Doppler device both at baseline and after 4 minutes of hand ischemia, which increases diameter through NO secretion mediated by an increase in flow and shear stress. Data were collected from 44 CHF patients (New York Heart Association class I to III) under standard treatment (diuretic, digitalis, and enalapril, 20 mg/d), in whom CHF severity was assessed by a cardiopulmonary stress test, and from 16 age- and sex-matched controls. CHF patients were then randomized to maintain for (A) 2 months of standard treatment (n=11), (B) treatment with double the ACE inhibitor dose (n=11), (C) standard treatment with an angiotensin II antagonist (losartan, 50 mg/d; n=11), or (D) standard treatment with bicycle training for 30 minutes, 3 times a week (n=11). At baseline, radial artery diameter and flow were similar in CHF patients and controls; CHF patients had a modest although significant impairment in flow increase (-36%) and a striking impairment (-78%) in diameter increase following the 4 minutes of ischemia. After 2 months, baseline diameter and flow remained unaltered in the 4 groups. After the 4 minutes of ischemia, radial artery flow and diameter increased as before in the group under standard treatment (A), whereas in the other 3 groups, the increase was significantly (P<0.05) and, for diameter, markedly (B, 83%; C, 92%; and D, 95%) greater. The vasodilatation induced by trinitroglycerin was similar in CHF and control subjects and not affected by treatments. In CHF, radial artery shows a marked reduction in flow-mediated vasodilation, reflecting impairment of endothelial function. This impairment can be markedly improved by treatments that effectively block the renin-angiotensin system either at ACE or at ACE plus angiotensin receptor level. This is the case also with nonpharmacological treatment of CHF.
Giannattasio et al. (Sat,) conducted a rct in Congestive heart failure (n=60). Double ACE inhibitor dose, addition of losartan, or bicycle training vs. Standard treatment (diuretic, digitalis, and enalapril 20 mg/d) was evaluated on Increase in radial artery diameter following 4 minutes of ischemia (p=<0.05). Doubling the ACE inhibitor dose, adding losartan, or bicycle training significantly improved radial artery diameter increase by 83%, 92%, and 95% respectively in CHF patients (P<0.05).