title: Effect of the angiotensin receptor blocker Valsartan on coronary microvascular flow reserve in moderately hypertensive patients with stable coronary artery disease.
abstract: OBJECTIVE
  To noninvasively investigate the effects of the angiotensin receptor blocker (ARB) Valsartan. on myocardial microcirculation in moderately hypertensive patients with stable coronary artery disease (CAD).
  
  
  RESULTS
  In this prospective open-label study, patients with mild stable CAD and moderate systolic and/or diastolic hypertension were treated with 160 mg Valsartan daily. Myocardial blood flow was quantified noninvasively using positron emission tomography (PET) with N-13 ammonia at baseline, after one week and after 16 weeks. Mean blood pressure at rest improved significantly from baseline to week 16 (105 +/- 10 vs. 98 +/- 9 mm Hg: p = 0.017, n = 12), but no significant change was observed after one week (103 +/- 11 vs. 100 +/- 11, p = 0.43, n = 13). PET analysis revealed that flow increase during endothelial-dependent, sympathetic stimulation by cold pressor testing (CPT) and in response to pharmacologic vasodilation with adenosine improved from baseline after 1 week (CPT: 1.10 +/- 0.3 vs. 1.37 +/- 0.3; p = 0.017, adenosine: 2.34 +/- 0.52 vs. 2.91 +/- 0.81; p = 0.048) and at week 16 (CPT: 1.15 +/- 0.4 vs 1.39 +/- 0.2; p = 0.10, adenosine: 2.34 +/- 0.52 vs 2.81 +/- 0.91; p = 0.039).
  
  
  CONCLUSIONS
  In patients with stable coronary disease, ARB results in improved PET-determined microvascular flow reserve. Improvements in microcirculation preceded the reduction of blood pressure, suggesting direct beneficial effects on microvascular function.
authors: Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Munich, Germany.
authors: Takahiro
authors: T
authors: Higuchi
authors: Claudia
authors: C
authors: Abletshauser
authors: Stephan G
authors: SG
authors: Nekolla
authors: Markus
authors: M
authors: Schwaiger
authors: Frank M
authors: FM
authors: Bengel
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011859:Radiography; D013777:Tetrazoles / Q000008:administration & dosage*; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine