Angiotensin receptor antagonist regresses left ventricular hypertrophy associated with diabetic nephropathy in dialysis patients.
BACKGROUND
Left ventricular hypertrophy (LVH) is frequently found at the initiation of dialysis therapy for diabetic and hypertensive patients, and is highly predictive of future cardiac morbidity and mortality. Angiotensin type 1 receptor (AT1) antagonists may be able to regress LVH by mechanisms independent of their antihypertensive effects in diabetic patients. It is not known whether AT1 antagonists are able to reverse LVH in diabetic patients on dialysis therapy.


METHODS
Twenty-four type II diabetic patients with end-stage renal disease who had just entered into hemodialysis therapy, and were diagnosed as having LVH evaluated by echocardiography, were selected from 3 dialysis units staffed by the faculty of Saitama Medical School between 1998 and 2001. The study was carried out for 1 year. All patients were randomly assigned to 2 groups. One group received an AT 1 antagonist, losartan 100 mg daily 30 minutes after the cessation of dialysis therapy on dialysis days, or in the evening when dialysis therapy did not occur. The control group received placebo. LVH was evaluated by echocardiography before the start of administration of drugs, at 4 and 8 months, and again at 12 months after the start of drug therapy. A systolic blood pressure of less than 140 mm Hg was the target blood pressure in both groups.


RESULTS
Using repeated measures analysis of variance, applied to those with 4 echocardiograms, there were progressive decreases over time in the left ventricular mass index (LVMi), posterior wall thickness, and intraventricular wall thickness in patients receiving losartan. The biggest changes in mass and the other parameters occurred between baseline and at month 6. Compared with these changes in the patients receiving losartan, left ventricular internal diameters and their derived parameters (e.g., ejection fraction) remained unchanged throughout the study. In spite of a similar reduction of bp in the patients receiving placebo, no significant changes in echocardiographic parameters were found in these patients.


CONCLUSIONS
An AT 1 antagonist, losartan, is beneficial for the regression of LVH in diabetic patients who started dialysis therapy under adequate blood pressure control.
Kanno
Yoshihiko
Y
Department of Nephrology, Saitama Medical School, Saitama, Japan.
Kaneko
Keiko
K
Kaneko
Masaharu
M
Kotaki
Syuhei
S
Mimura
Taku
T
Takane
Hiroshi
H
Suzuki
Hiromichi
H
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002118:Calcium / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D019808:Losartan; D002118:Calcium