Evaluation of the Effect of Treatment with Angiotensin Type 1 Receptor Blockers in Hypertensive Patients by Exercise Tissue Doppler Echocardiographic Parameters

Öz

Objective: The current study aims to examine the effect of Telmisartan treatment on functional and structural cardiac change at rest and during exercise in hypertensive (HT) patients using conventional echocardiography (ECHO) and tissue Doppler ultrasound (US). Materials and Methods: A total of 26 patients (16 female, 10 male with a mean age of 51.9±8.54) with a diagnosis of essential HT were included in the study. Arterial blood pressure measurements, conventional ECHO and tissue Doppler US recordings during rest and stress (cycling ergometry) periods were taken before the treatment and after 6 months of follow-up. Results: The mean blood pressure of the patients decreased from 109.8±4.6 mmHg to 92.2±6.4 mmHg (p<0.05). After telmisartan treatment, it was determined that there was a significant improvement in diastolic function and myocardial performance index (MPI) values measured by tissue Doppler during rest and stress with telmisartan treatment (p<0.05). Conclusion: Telmisartan monotherapy provides blood pressure control in patients with essential HT and enables significant improvements in left ventricular hypertrophy, cardiac functions at rest and during exercise, and structural changes.

Anahtar Kelimeler

• Hypertension
• angiotensin receptor blocker
• tissue Doppler imaging

Hipertansif Hastalarda Angiotensin Tip 1 Resptör Blokörleri ile Tedavi Etkisinin Egzersiz Doku Doppler Ekokardiyografik Parametrelerle Değerlendirilmesi

Öz

Giriş ve Amaç: Bu çalışmada hipertansif (HT) hastalarda Telmisartan tedavisinin altı aylık dönemde dinlenim ve egzersiz esnasında fonksiyonel ve yapısal kardiyak değişime etkisini konvansiyonel ekokardiyografi (EKO) ve doku Doppler ultason (US) kullanarak incelemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya yaş ortalaması 51.9±8.54 olan esansiyel HT tanılı 26 hasta (16 kadın, 10 erkek) alındı. Hastalara Telmisartan 80 mg/gün tedavisi verildi. Tedavi öncesinde ve 6 aylık izlemin ardından arteriyel kan basıncı ölçümleri ile dinlenim ve stres (bisiklet ergometrisi) esnasında konvansiyonel EKO ve doku Doppler US kayıtları alındı. Bulgular: Hastaların ortalama kan basıncı 109,8±4,6 mmHg’den 92,2±6,4 mmHg’ye geriledi (p<0.05). Telmisartan tedavisi sonrasında dinlenim ve stres esnasında da doku Doppler ile ölçülen diyastolik fonksiyon belirteçlerinde ve miyokard performans indeks (MPI) değerlerinde telmisartan tedavisiyle anlamlı düzelme olduğu saptandı (p<0.05). Sonuç: Telmisartan monoterapisi esansiyel HT tanılı hastalarda kan basıncı kontrolünü sağlamakta, sol ventrikül hipertrofisini, dinlenme ve egzersiz sırasındaki kardiyak fonksiyonları ve yapısal değişikliklerde anlamlı düzelme sağlamaktadır.

Anahtar Kelimeler

• Hipertansiyon
• angiotensin reseptör blokeri
• doku Doppler görüntüleme

Kaynakça

1. Mills, K.T, Stefanescu, A, He, J, The global epidemiology of hypertension, Nature Reviews Nephrology, 2020, 16(4), 223–37.
2. Poulter, N.R, Borghi, C, Parati, G, et al., Medication adherence in hypertension, Journal of Hypertension, 2020, 38(4), 579–87.
3. Okwuosa, T.M, Soliman, E.Z, Lopez, F, Williams, K.A, Alonso, A, Ferdinand, K.C, Left ventricular hypertrophy and cardiovascular disease risk prediction and reclassification in blacks and whites: The Atherosclerosis Risk in Communities Study, American Heart Journal, 2015, 169(1), 155-161.
4. Williams, B, Mancia, G, Spiering, W, et al., 2018 ESC/ESH Guidelines for the management of arterial hypertension, Journal of Hypertension, 2018, 36(10), 1953–2041.
5. James, P.A, Oparil, S, Carter, B.L, et al., 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, JAMA, 2014, 311(5), 507.
6. Marwick, T.H, Gillebert, T.C, Aurigemma, G, et al., Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE), Journal of the American Society of Echocardiography, 2015, 28(7), 727–54.
7. Niemann, M, Breunig, F, Beer, M, et al., Tei Index in Fabry Disease, Journal of the American Society of Echocardiography, 2011, 24(9), 1026–32.
8. Devereux, R.B, Alonso, D.R, Lutas, E.M, et al., Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings, American Journal of Cardiology,, 1986, 57(6), 450–8.

9. Lang, R.M, Badano, L.P, Mor-Avi, V, et al., Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, Journal of the American Society of Echocardiography, 2015, 28(1), 1-39.
10. Biering-Sørensen, T, Biering-Sørensen, S.R, Olsen, F.J, et al., Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population, Circulation: Cardiovascular Imaging, 2017, 10(3).
11. Nagueh, S.F, Smiseth, O.A, Appleton, C.P, et al., Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, Journal of the American Society of Echocardiography, 2016, 29(4), 277–314.
12. Tei, C, Ling, L.H, Hodge, D.O, et al., New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy, Journal of Cardiology, 1995, 26(6), 357–66.
13. Galiè, N, Hinderliter, A.L, Torbicki, A, et al., Effects of the oral endothelin-receptorantagonist bosentan on echocardiographicand doppler measures in patients with pulmonary arterial hypertension, Journal of the American College of Cardiology, 2003, 41(8), 1380–6.
14. Bach, D.S, Armstrong, W.F, Donovan, C.L, Muller, D.W.M, Quantitative Doppler tissue imaging for assessment of regional myocardial velocities during transient ischemia and reperfusion, American Heart Journal, 1996, 132(4),721–5.
15. Elton, T.S, Martin, M.M, Angiotensin II Type 1 Receptor Gene Regulation, Hypertension, 2007, 49(5), 953–61.
16. Izzo, J.L, Levy, D, Black, H.0.R, Importance of Systolic Blood Pressure in Older Americans, Hypertension, 2000, 35(5):1021–4.
17. Lieb, W, Gona, P, Larson, M.G, et al., The Natural History of Left Ventricular Geometry in the Community, JACC Cardiovascular Imaging, 2014, 7(9), 870–8.
18. Mizuguchi, Y, Oishi, Y, Miyoshi, H, Iuchi, A, Nagase, N, Oki, T, Beneficial effects of telmisartan on left ventricular structure and function in patients with hypertension determined by two-dimensional strain imaging, Journal of Hypertension, 2009, 27(9), 1892–9.
19. Futai, R, Ito, T, Kawanishi, Y, Terasaki, F, Kitaura, Y, Olmesartan ameliorates myocardial function independent of blood pressure control in patients with mild-to-moderate hypertension, Heart Vessels, 2009, 24(4), 294–300.
20. Dahlöf, B, Pennert, K, Hansson, L, Reversal of Left Ventricular Hypertrophy in Hypertensive Patients, American Journal of Hypertension, 1992, 5(2), 95–110.
21. Burnier, M, Telmisartan: A Different Angiotensin II Receptor Blocker Protecting a Different Population? Journal of International Medical Research, 2009, 37(6), 1662–79.
22. Wienen, W, Entzeroth, M, Meel, J.C.A, et al., A Review on Telmisartan: A Novel, Long-Acting Angiotensin II-Receptor Antagonist, Cardiovascular Drug Reviews, 2006, 18(2), 127–54.
23. Krum, H, Lambert, E, Windebank, E, Campbell, D.J, Esler, M, Effect of angiotensin II receptor blockade on autonomic nervous system function in patients with essential hypertension, American Journal of Physiology: Heart and Circulatory Physiology, 2006, 290(4), H1706–12.
24. Fogari, R, Preti, P, Zoppi, A, et al., Effect of Telmisartan/Hydrochlorothiazide Combination Versus Nifedipine GITS on Ambulatory Blood Pressure and Sympathetic Activation, American Journal of Hypertension, 2005, 18(5), 577–83.
25. Galzerano, D, New standards in hypertension and cardiovascular risk management: focus on telmisartan, Vascular Health Risk Management, 2010, 113.