Angiotensin II Receptor Blockers or Straight Renin Inhibitor Influence Upon Morphological and Functional Heart and Central Hemodynamics Indices in Hypertensive Patients After Ischemic Stroke

Abstract

Arterial hypertension (AH) in the world and in Ukraine is the main cause of strokes and chronic cerebral dyscirculation with constantly growing incidence. The risk of recurrent stroke grows with increase of concomitant risk factors and AH target organs damage. Asymptomatic target organs damage, especially, LV hypertrophy, etc., is one the potent factors for cerebral vascular complications in hypertensive patients. That is why treatment of heart anatomy alterations, as a target organ, is of great importance in cardiovascular continuum for primary and secondary prevention of cardiovascular, including cerebrovascular end-points.

The objective: of the study was to evaluate the influence of AH medication treatment by angiotensin receptors type II blockers (ARB) and straight renin inhibitor upon morphological and functional heart indices and central hemodynamics in hypertensive patients after ischemic stroke (IS) during 1 year follow-up according to stroke and vascular hospital departments experience.

Patients and methods. We prospectively included 135 hypertensive pts. without AF history after IS aged 36-78 years  (61,0±9,1 yrs.), hospitalized to stroke and vascular hospital departments of Ternopol regional community psycho-neurological hospital (TRCPNH) over the period Nov. 2011 – Dec. 2013 р. All pts. underwent Doppler EchoCG. Along with fundamental therapy pts. were randomly prescribed Losartan 50-100 mg/day (40 pts.), Olmesartan 20-40 mg/day (48 pts) or Aliskiren 150-300 mg/day. Control EchoCG was performed in 6 and 12 months from trearment start.

Results. Among the pts. with AH after IS usually there are pts. with low NYHA class of CHF, with LVEF correlating with NYHA functional class ( –0,47, p<0,0001), with predominantly concentric LV geometry (97,8%), correlating with NYHA functional class. NYHA FC significantly correlates with most morphological and functional left and right remodeling indices, while LV volumes significantly correlate with LV systolic function. ARB administration (Losartan or Olmesartan) for AH treatment leads to marked significant regress of LV hypertrophy and hypertensive remodeling already in 6 months of treatment with central hemodynamics improvement with similar changes in both sartans groups without significant difference between indices. In Aliskiren group (3) in 6 months of treatment pts. Showed significantly higher LA dimensions compared to Losartan group, thicker LV walls compared to both sartan groups, and higher LV RWTh. Central hemodynamics indices, namely, LV diastolic function, LV preload and smaller circulation pressure in 6 months after treatment did not significantly differ between the groups.

Conclusions. In Aliskiren group in 12 months of treatment there also were certain positive changes compared to start data, witnessing of reverse LV remodeling. But at the same time Aliskiren group showe significantly higher LV walls thickness (р=0,0051 and р<0,0001 for IVS, and р<0,0001 and р<0,0001 fro LVPW, respectively), and higher LV MMi (р=0,0003 and р=0,0002, respectively) compared both to Losartan and Olmesartan groups, with preservation of concentric LV geometry and LV hypertrophy. Also, Aliskiren group showed significantly worse LV diastolic function and preload indices, allowing to conclude about insufficient cardioprotection with Aliskiren in treating AH after IS, and significant benefit from ARB.