Pioglitazone improves left ventricular diastolic function in patients with essential hypertension

BACKGROUND: Left ventricular (LV) hypertrophy and diastolic dysfunction, which are common cardiac consequences of hypertension, are modified by insulin resistance. The present study assessed the hypothesis that primary treatment of insulin resistance may reverse such cardiac changes in hypertensive patients. METHODS: A total of 30 patients with essential hypertension were enrolled in this study. In echocardiographic examinations, LV mass index, the peak velocity ratio of early diastolic to atrial filling (E/A), and the E-wave deceleration time (DcT) were determined. Insulin sensitivity test with steady-state plasma glucose (SSPG) method, oral glucose tolerance test, and blood samplings for measurement of adiponectin and matrix metalloproteinase (MMP)-2 were also performed. Six months after treatment with pioglitazone (30 mg/day), an insulin sensitizer, these examinations were repeated. RESULTS: Pioglitazone significantly increased E/A and decreased DcT, without a change in LV mass index. These improvements in diastolic properties were much greater in subjects with a marked (>or==3.3 mmol/L) decrease in SSPG (n=11) than the others (n=19), although the decrease in glucose levels did not differ between the two groups. In addition, the changes in E/A and DcT were closely correlated with the decrease in SSPG. Pioglitazone treatment significantly elevated plasma adiponectin and MMP-2 levels, and the increase in MMP-2 was positively correlated with the increase in adiponectin. CONCLUSIONS: The present findings demonstrate that pioglitazone improves LV diastolic function without LV mass regression in hypertensive patients in proportion to the amelioration of insulin resistance. These findings suggest that increased adiponectin and MMP may be involved in the beneficial effect of pioglitazone on diastolic function.     

老年高血压病人左室肥厚与左室舒张功能的关系

目的：研究老年高血压病人左室肥厚与左室舒张功能各参数的关系,探讨在老年人左室肥厚对左室舒张功能的影响。方法：用彩色多普勒超声心动图测量101例老年高血压病人左心室结构及舒张功能参数。结果：101例高血压病人中,左室肥厚组（48例）的左房内径指数（LADI）、等容舒张时间（IVRT）、舒张期二尖瓣E波减速时间（EDT）显著大于左室正常组（53例,P〈0．05～〈0．01）．多元逐步回归分析发现,左室质量指数（LVMI）与左房射血分数（LAEF）、LADI、IVRT和EDT有明显的相关关系（r分别为0．213,0．251．0．450．0．338．P〈0．05～0．001）结论：老年高血压病人的左室增厚可进一步降低左室舒张功能。     

The left ventricular diastolic function in patients with hypertension and calcium inhibitors

One of the first detectable signs of hypertensive heart disease is impairment of left ventricular filling. This filling defect depends, although not exclusively, on left ventricular hypertrophy (LVH), load factors and ischemic factors. LVH is an adaptive phenomenon triggered by the dysfunction of various parameters, such as increased in peripheral resistance, reduced arterial elasticity and increased sodium reserve. Calcium channel inhibitors act at several levels to permit regression of the LVH and contribute to improved left ventricular filling conditions.     

原发性高血压患者ST-T向量与左心室舒张功能关系的研究

目的　探讨立体心电图 ST-T向量与左心室舒张功能的关系 ,并与超声心动图对左心室舒张功能 (L VDF)比较评价二者的相关性和敏感性。方法　应用 M型、脉冲多普勒超声心动图对 12 7例原发性高血压患者测定左心房内径 (LAD)、左心室质量指数(LVMI)、EF斜率、射血分数、二尖瓣口血流频谱 A峰 ,E峰 ,A/E比值 ,同时用立体心电图仪对 12 7例原发性高血压患者及 3 0例正常对照组 ST-T向量。结果　原发性高血压左心室肥大 (LVH)组较非左心室肥大 (NL VH)组 A/E比值显著增大。原发性高血压LVH和 NLVH组与对照组比较 ST-T向量各指标均有差异 ;A/E比值与立体心电图 ST-T向量判定 LVDF障碍显著有关联 ,且ST-T向量较 UCG更敏感 ;多元线性回归示 A/E比值与 ST-T向量积分 ,心率 ,年龄 ,危险度分层相关。结论　立体心电图 ST-T向量及其积分与 A/E比值相关良好 ,且可能比后者更为敏感     

培哚普利治疗高血压患者左室舒张功能的疗效

目的:观察培哚普利对原发性高血压(EH)患者左心室舒张功能的影响。方法:采用自身对照开放试验方法,观察50例EH患者培哚普利治疗6月后,左心室舒张内径(LVDd)、舒张期室间隔厚度(IVST)、舒张末期左心室后壁厚度(LVPWT)、左心室重量指数(LVMI)、二尖瓣口E峰、A峰、A/E比值的变化。结果:50例EH患者治疗6个月后,IVST、LVPWT、LVMI明显下降(P<0.05),A峰、A/E比值亦明显下降(P<0.05)。结论:培哚普利在降压的同时,不但能逆转左心室肥厚,并且能有效改善左心室舒张功能。     

瑞舒伐他汀对老年高血压患者左心室舒张功能的影响

目的:评价瑞舒伐他汀对老年高血压患者左心室舒张功能的影响。方法:选取服用降压药的老年高血压患者128例,随机分为治疗组和对照组,治疗组给予口服瑞舒伐他汀6个月,分别测定两组患者治疗前后左心室后壁舒张末期厚度(LVPWT)、室间隔舒张末期厚度(IVST)、舒张早期峰值流速(E)、舒张晚期峰值流速(A)和E/A值,同时测定两组患者治疗前后血压、血脂的变化。结果:与治疗前相比,治疗组与对照组患者的SBP,DBP以及脉压差均明显降低(均P0.05);治疗组患者治疗后血清TC、TG、LDL-C均显著降低(P0.01),同时治疗组患者治疗后LVPWT、IVST、A均显著降低(P0.01);E明显升高(P0.01);E/A值明显升高(P0.05)。而对照组这些指标未见显著差异。结论:老年高血压患者在降压的同时联用瑞舒伐他汀能改善左心室舒张功能。     

Impact of diabetes on left ventricular diastolic function in patients with arterial hypertension

AIMS: To analyse the effect of diabetes (DM) on diastolic function in hypertensive patients. METHODS: 439 hypertensive patients were selected for participation in this study. All participants had an echocardiographic evaluation of systolic and diastolic function. The overall degree of diastolic function and specific parameters (e.g. E/Ea ratio) were analysed. RESULTS: We divided the cohort (63+/-10 years) into those with diabetes mellitus (DM(+), n=124) and without diabetes mellitus (DM(-), n=315). The prevalence of normal diastolic function was lower in DM(+) than DM(-) (19.4% vs. 30.8%); mild (65.3% vs. 60.0%) and moderate/ severe diastolic dysfunction were more frequent in DM(+) (15.3% vs. 9.2%, p=0.022). The E/Ea ratio, an estimate of left ventricular end-diastolic pressure, was significantly higher in DM(+) (12.3+/-4.4) as compared to DM(-) (10.8+/-3.6, p<0.001). Sex-specific analysis revealed that the effect of DM on diastolic function was mainly limited to the male subgroup. Multivariate logistic regression analysis showed that diabetes affected diastolic function in males independent of blood pressure, left ventricular mass index, concomitant medication and prevalence of coronary artery disease. CONCLUSION: Diabetes negatively affects diastolic function in patients with arterial hypertension. This effect is mainly confined to the male subgroup.     

曲美他嗪对老年高血压患者舒张功能的影响

目的利用观察组织多普勒显像(TDI)技术评价曲美他嗪对不伴有左心室肥厚的老年高血压患者舒张功能的影响。方法选择合并舒张功能不全的老年高血压患者68例,排除左心室肥厚,随机分为2组:治疗组,除常规治疗外给予口服曲美他嗪20mg,每日3次;对照组给予常规治疗;2组疗程均为3月。2组治疗前后用TDI技术测量二尖瓣环侧壁舒张早期运动速度(e波)、舒张晚期运动速度(a波)并计算e/a比值,测量血流多普勒指标二尖瓣口舒张早期血流速度(E波)、舒张晚期血流速度(A波)及E/A比值。结果 2组3月后E波、E/A、e波、e/a较治疗前升高(P<0.05),2组间比较无明显差异。结论曲美他嗪在常规治疗基础上并不能明显改善老年高血压患者左室舒张功能。     

螺内酯治疗高血压病并左心室舒张功能不全的观察

目的:观察螺内酯对高血压病合并无症状性左心室舒张功能不全的影响.方法:选择高血压病合并无症状性左心室舒张功能不全患者共126例,随机分为常规治疗组(68例)和螺内酯组(58例).两组患者均按常规综合治疗,而螺内酯组在此基础上加用螺内酯片治疗.治疗前后观察患者血压、心率的变化,以彩色多普勒超声仪检测E峰(EV)、A峰(A...     

Heart rate variability and left ventricular diastolic function in patients with borderline hypertension with and without left ventricular hypertrophy

The relationships between heart rate variability (HRV), left ventricular mass and diastolic function in borderline hypertensive patients (BHT) were evaluated. 24 h Holter electrocardiogram (ECG) and blood pressure (BP) monitoring, M and 2 D echocardiogram and Doppler analysis in 42 BHT with and without left ventricular hypertrophy (LVH) and in 20 normotensive controls were assessed. From 24-h ECG, time domain indexes of HRV were calculated. Standard Deviation of all Cycles (SDNN) and Standard Deviation of the means of heart periods over five-minute intervals (SDANN) were significantly reduced in BHT with LVH but not in BHT without LVH. No significant differences of short-term variability measures were detectable, although a progressive decrease among control subjects and BHT with and without LVH was observed. Diastolic left ventricular compliance evaluated by early to late transmitral flow velocity ratio (E/A ratio) significantly declined from normotensive subjects to BHT with LVH. There was a significant positive correlation between E/A and SDNN and SDANN throughout all studied groups. This indicates that BHT with LVH has a reduced HRV compared to other groups. This impairment is probably related to left ventricular mass and left ventricular filling abnormalities.     

Effects of nitrendipine on diastolic left ventricular function and hypertrophy in patients with hypertension

To assess the effects of antihypertensive therapy on the heart, left ventricular mass and performance indices (determined by M-mode and pulsed Doppler echocardiography) were compared before and after 4-5 months of nitrendipine therapy in 19 primary hypertensive patients (stage I and II). MAP was reduced from 17.1 +/- 1.7 to 14.5 +/- 1.7 kPa (128.5 +/- 12.7 to 109.0 +/- 13.1 mm Hg), P less than 0.001. The heart rate increased from 68 +/- 8 to 70 +/- 8 beats/min (P greater than 0.05). None of the indices for systolic function (SV, SI, CO, CI, EF, FS) changed significantly (P greater than 0.05). But the indices for diastolic function (RFF, RFR, VLef, IRP, EFv, A/E) improved remarkably (P less than 0.001 or 0.05). Furthermore, a positive correlation between the increasing rate of VLef and decreasing rate of MAP (r = 0.58, P less than 0.005) was noticed. Therefore, the decreasing in arterial pressure is considered as a major relative factor in the improvement of diastolic dysfunction. The patients were divided into two groups according to LVMI: group A, 11 patients with LVMI greater than or equal to 125 g/m2; while group B, 8 patients with LVMI less than 125 g/m2. The LV diastolic relaxation index IRP improved to a greater degree in group B (P less than 0.05), although the reduction of MAP was more markable in group A (P less than 0.05). This means that factors other than arterial pressure may influence the LV diastolic relaxation. In group A, the LVMI decreased from 155.1 +/- 29.9 to 144.4 +/- 33.0 g/m2 (a reduction of 7.0 +/- 9.0%). It suggests that LV hypertrophy can be "reversed" following nitrendipine therapy in some of the hypertensive patients.     

Bisoprolol improves echocardiographic parameters of left ventricular diastolic function in patients with systemic hypertension

Left ventricular (LV) diastolic dysfunction (LVD) is a common complication secondary to hypertension. It has been reported that bisoprolol is effective in reducing blood pressure and has beneficial cardiac effects in patients with hypertension. However, its effect on LV diastolic function has not been studied in detail. In this study, we sought to determine bisoprolol's effect on left ventricle diastolic function. Data from 25 patients were statistically analyzed. Peaks E and A wave, E/A ratio, isovolumetric relaxation time and E wave deceleration time were measured echocardiographically. Doppler echocardiography measurements after bisoprolol treatment revealed an improvement in LV diastolic function. In conclusion, our results show that treatment with bisoprolol, improves echocardiographic parameters of LV diastolic function after 3 months of treatment.     

Contribution of hypertension to left ventricular diastolic function in patients with asymmetrical apical hypertrophy

This study was designed to ascertain the contribution of hypertension to the early diastolic time intervals in asymmetrical apical hypertrophy (AAH). Eighteen patients with untreated AAH were categorized as those with (n = 13) and without (n = 5) hypertension. Isovolumic relaxation time and early diastolic filling were determined in four groups: normotensive subjects (n = 20), patients with essential hypertension (n = 20), AAH with hypertension, and AAH without hypertension. Early diastolic function was measured by the interval from the aortic closure sound (IIA, phonocardiography) to the opening of the mitral valve (MVO, echocardiography) and the interval from MVO to the O point of the apexcardiogram. The IIA-O interval was also calculated. Peak velocities in the rapid filling phase (R) and atrial contraction phase (A) were measured using two-dimensional Doppler echocardiography in the center of the mitral orifice in diastole. The MVO-O/IIA-MVO and A/R ratios were also calculated. 1. In the AAH with and without hypertension groups, the IIA-O, IIA-MVO, and MVO-O intervals were significantly prolonged. The IIA-O and MVO-O intervals in the AAH without hypertension group were more prolonged than were those in the AAH with hypertension group. In patients with essential hypertension, the IIA-O and the IIA-MVO intervals were prolonged, but there was no prolongation of the MVO-O interval. 2. The MVO-O/IIA-MVO ratio was lower in essential hypertension and in the AAH with hypertension groups, and significantly higher in the AAH without hypertension group. 3. There was no significant change of the R, A, and A/R in each group. These results indicated that prolonged left ventricular relaxation was distinguished in essential hypertension. In AAH with hypertension, the same prolongation was observed, but the disturbance of early diastolic filling was mild. It is suggested that apical hypertrophy has a possible association with hypertension, though it may more properly belong to cardiomyopathy.     

一氧化氮、醛固酮对高血压左室肥厚及左室舒张功能的影响

目的:探讨一氧化氮(NO)、醛固酮(ALD)在高血压左室肥厚(LVH)形成中的作用及对左室舒张功能的影响。方法:以超声心动图检查55例原发性高血压(EH)患者和30例正常人并计算左室重量指数(LVMI),测定左室舒张功能等指标,并测定空腹血清NO、ALD水平,进行组间比较。结果:EH组与正常人相比NO水平降低、ALD 水平升高,左室舒张功能降低(P均<0.01)。EH-LVH组与EH组相比NO水平降低、ALD水平升高更明显(P< 0.01)。NO、ALD与LVMI相关系数(r)分别为-0.46和0.50(P<0.05)。NO、ALD与左室舒张指标E/A和PFR/ PAFR的,r分别为0.37、0.43、-0.42、-0.37(P<0.05)。结论:原发性高血压患者NO、ALD水平与LVMI和左室舒张功能减退呈显著相关性。     

内源性类洋地黄物质对高血压病患者左室舒张功能的影响

测定 2 0例正常人和 2 0例高血压病患者的心尖搏动图指数、血清内源性类洋地黄物质 （EDL S）浓度、红细胞膜 Na+ - K+ - ATP酶 （钠泵 ）活性及红细胞内钾、钠、钙总量。结果显示 ,与正常人比较 ,高血压病患者的房缩波与E- O垂直高度比值 （A/E- O）明显增高 ,等容舒张期 （IRT）明显延长 ,血清 EDL S浓度明显升高 ,红细胞膜钠泵活性下降 ,红细胞内钠、钙含量升高、钾含量下降 ,且血清 EDL S浓度与 A/E- O,IRT呈显著正相关。提示 EDL S可能参与高血压病患者左室舒张功能异常的形成 ,其机制可能与 EDL S抑制心肌细胞膜钠泵活性并导致细胞内 Ca2 +含量升高有关     

Effect of eprosartan on left ventricular diastolic function and cerebral hemodynamics in patients with hypertension

Eprosartan (600-1200 mg/day) was given for 4 weeks to 28 patients aged 32-62 years with stage II-III hypertension (WHO, 1999). Left ventricular diastolic function and cerebral blood flow were assessed by echocardiography and ultrasound dopplerography. Treatment with eprosartan was associated with improvements of impaired left ventricular diastolic function, structural and functional state of the heart, venous outflow from cerebral vessels, and restoration of unpaired autoregulation of cerebral blood flow. All these phenomena could potentially lead to normalization of cerebral tissue perfusion and stabilization of cerebral blood flow.     

缬沙坦对原发性高血压左心室肥厚及舒张功能的影响

目的 评价缬沙坦对高血压患者左心室肥厚及左心室舒张功能的影响。方法 选原发性高血压并左心室肥厚患者48例,随机分为缬沙坦治疗组和硝苯地平缓释片治疗组（对照组）,治疗6个月,控制收缩期血压低于或等于140 mm Hg（1mm Hg=0.133kPa）,舒张期血压低于或等于95 mm Hg。于治疗前、治疗3个月、6个月作体格检查、血生化及心脏超声检查,记录心率、收缩压、舒张压、左心室舒张末期内径、室间隔厚度、左心室后壁厚度、左心室射血分数、舒张早期和晚期最大速度比值（E/A比值）,计算左心室重量指数。结果 调整用药后两组患者血压均达目标值;治疗3个月后两组病人左心室重量指数和E／A即显示差异,但缺乏统计学意义;治疗6个月后缬沙坦治疗组的左心室重量指数和E／A比值较对照组改善明显,而两组治疗前后左心室射血分数均无明显变化。结论 相对于硝苯地平缓释片,缬沙坦对于原发性高血压患者的左心室肥厚和左心室舒张功能有更明显的改善,这种受益是独立于其降压作用之外的。