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).
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.
p-value: p=< 0.001
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.
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).