Key result
Telmisartan therapy for 12 months in hypertensive patients improved left ventricular geometric remodeling and regional myocardial contraction and relaxation beyond blood pressure reduction.
Why the study?
Does telmisartan improve left ventricular structure and myocardial mechanics beyond blood pressure reduction in previously untreated patients with hypertension?
Observational (n=65)
Does telmisartan improve left ventricular structure and myocardial mechanics beyond blood pressure reduction in previously untreated patients with hypertension?
Long-term telmisartan therapy improves left ventricular geometric remodeling and myocardial mechanics in hypertensive patients beyond its blood pressure-lowering effects.
Telmisartan may improve LV remodeling beyond BP reduction in hypertension; hypothesis-generating and requires RCT confirmation before practice change.
Background Telmisartan is an angiotensin II receptor blocker with established beneficial effects on cardiac structure and function in animal models. Our aim was to clinically clarify the cardiprotective ability, beyond lowering blood pressure (BP), of telmisartan on left ventricular (LV) myocardial mechanics in patients with hypertension using a two-dimensional (2-D) strain imaging. Methods Telmisartan (20–40 mg daily) was administered to 35 previously untreated patients with hypertension. Conventional and 2-D strain echocardiography were performed after medication had been continued for 1–2 months with values of systolic BP less than 140 mmHg and diastolic BP less than 90 mmHg (phase I) and for 12 months (phase II) in all patients and 30 age-matched normal individuals. Results There were no differences in BP, LV ejection fraction, and ratio of peak early to late diastolic transmitral flow velocity (E/A) between phases I and II of hypertension group and normal group. In phase I, the mean peak systolic strains and strain rates in the longitudinal and circumferential directions, mean peak early diastolic strain rates in the longitudinal, circumferential, and radial directions, and mean peak atrial systolic strain rate in the longitudinal direction were lower than those in the normal group. In phase II, the LV mass index, relative LV wall thickness, isovolumic relaxation time, torsion and torsional rate were decreased, whereas the mean peak systolic strains and early diastolic strain rates in all the three directions, mean peak systolic strain rates in the longitudinal and circumferential directions, and mean peak atrial systolic strain rate in the longitudinal direction were increased compared with phase I. Conclusion The use of telmisartan in patients with hypertension improved not only LV geometric remodeling but also regional LV myocardial contraction and relaxation in the three directions, especially longitudinal and circumferential directions. Our results support beneficial effects on LV structure and function beyond BP reduction from continuous long-term telmisartan therapy.
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Mizuguchi et al. (2009) conducted an observational in Hypertension (n=65). Telmisartan vs. Age-matched normal individuals and Phase I (1-2 months of therapy) was evaluated on Left ventricular myocardial mechanics (2-D strain imaging). Telmisartan therapy for 12 months in hypertensive patients improved left ventricular geometric remodeling and regional myocardial contraction and relaxation beyond blood pressure reduction.