Both ramipril and telmisartan reverse indices of early diabetic cardiomyopathy: a comparative study.
OBJECTIVE
We tested the hypothesis that renin-angiotensin system inhibition could reverse left ventricular diastolic dysfunction in patients with type 2 diabetes.


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
Phivos
P
Department of Cardiology, Euroclinic Hospital, Athens, Greece. phisym@hotmail.com
Koulouris
Spyridon
S
Vratsista
Ekaterini
E
Triantafyllou
Konstantinos
K
Ioannidis
Georgios
G
Thalassinos
Nikolaos
N
Katritsis
Demosthenes
D
D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018592:Cross-Over Studies; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017257:Ramipril / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D000077333:Telmisartan; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001565:Benzoates; D020097:Natriuretic Peptide, Brain; D017257:Ramipril; D000077333:Telmisartan