Key result
Ramipril, telmisartan, and their combination significantly improved left ventricular diastolic indices (E/A increased up to 36%) and reduced plasma BNP levels (up to 36% reduction) (p < 0.001).
Why the study?
Does renin-angiotensin system inhibition with ramipril, telmisartan, or their combination improve left ventricular diastolic dysfunction in asymptomatic patients with type 2 diabetes?
RCT (n=40)
Double-blind
Randomized
Does renin-angiotensin system inhibition with ramipril, telmisartan, or their combination improve left ventricular diastolic dysfunction in asymptomatic patients with type 2 diabetes?
In asymptomatic patients with type 2 diabetes, both ramipril and telmisartan, and especially their combination, improve echocardiographic indices of diastolic function and reduce BNP levels.
Answers are grounded in this paper and cite their sources.
Supports RAS inhibition for early diastolic dysfunction in asymptomatic diabetes; extends evidence to preclinical stages.
AIMS: We tested the hypothesis that renin-angiotensin system inhibition could reverse left ventricular diastolic dysfunction in patients with type 2 diabetes. METHODS AND RESULTS: Forty asymptomatic patients with type 2 diabetes were recruited in this double-blind cross-over trial. Left ventricular diastolic function was assessed at baseline with Doppler echocardiography; ratios of early to late peak flow velocity through the mitral orifice (E/A) and velocity time integral of early to late transmitral diastolic flow (VTIE/VTIA) were evaluated. In addition, plasma brain natriuretic peptide (BNP) was measured. Patients received randomly either ramipril (2.5 mg/day), or telmisartan (40 mg/day) or their combination for 3 months. Subsequently, every patient was crossed over to alternative regimens after a 2-week washout period. Measurements were repeated at the end of each treatment period. Both E/A and VTIE/VTIA ratios were increased (29 and 20% with ramipril, 25 and 23% with telmisartan and 36 and 28% with combination treatment, respectively, p < 0.001), whereas plasma BNP levels were significantly reduced with all 3 regimens (9% with ramipril, 25% with telmisartan and 36% with combination, p < 0.001). CONCLUSIONS: Both ramipril and telmisartan improve echocardiographic left ventricular diastolic indices and reduce plasma BNP levels in diabetic patients; their combination yields an even better therapeutic effect.
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Symeonides et al. (2006) conducted an RCT in Type 2 diabetes (n=40). Ramipril, telmisartan, or their combination vs. Cross-over (alternative regimens) was evaluated on Left ventricular diastolic function (E/A and VTIE/VTIA ratios) and plasma BNP levels (p=< 0.001). Ramipril, telmisartan, and their combination significantly improved left ventricular diastolic indices (E/A increased up to 36%) and reduced plasma BNP levels (up to 36% reduction) (p < 0.001).
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