Author(s): Symeonides P, Koulouris S, Vratsista E, Triantafyllou K, Ioannidis G, , Symeonides P, Koulouris S, Vratsista E, Triantafyllou K, Ioannidis G,
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Abstract AIMS: We tested the hypothesis that renin-angiotensin system inhibition could reverse left ventricular diastolic dysfunction in patients with type 2 diabetes. METHODS AND 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.
This article was published in Eur J Echocardiogr
and referenced in Journal of Clinical Trials