CLINICAL RESEARCH: HYPERTENSION
Comparative effects of valsartan versus amlodipine on left ventricular mass and reactive oxygen species formation by monocytes in hypertensive patients with left ventricular hypertrophy
Kenichi Yasunari, MD, PhD*,*,
Kensaku Maeda, MD*,
Takanori Watanabe, MD*,
Munehiro Nakamura, MD*,
Junichi Yoshikawa, MD, PhD, FACC* and
Akira Asada, MD, PhD*
* Department of General Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
Manuscript received October 1, 2003;
revised manuscript received December 9, 2003,
accepted December 15, 2003.
* Reprint requests and correspondence: Dr. Kenichi Yasunari, Department of General Medicine and Cardiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
yasunari{at}med.osaka-cu.ac.jp
OBJECTIVES: To compare the effects of the angiotensin receptor blocker (ARB) valsartan versus the calcium channel blocker amlodipine, reactive oxygen species (ROS) formation by monocytes, C-reactive protein (CRP), and left ventricular (LV) mass were studied in 104 hypertensive patients with left ventricular hypertrophy (LVH).
BACKGROUND: There is evidence that ARBs have blood pressure (BP)-independent effects on LV mass. Whether regression of LV mass by ARBs is correlated to ROS formation by monocytes and CRP is not fully understood yet.
METHODS: A cross-sectional and prospective study was performed. Participants were randomly assigned to either the 80-mg valsartan (n = 52) or 5-mg amlodipine (n = 52) group and were treated for eight months. The left ventricular mass index (LVMI) was calculated from two-dimensional M-mode echocardiography. Formation of ROS by monocytes was measured by gated flow cytometry. In addition, CRP, plasma renin activity, plasma aldosterone, and traditional risk factors were assessed.
RESULTS: Multiple regression analysis showed a significant correlation between LVMI and ROS formation by monocytes and between LVMI and CRP. Treatment reduced BP to a similar extent in both groups. Valsartan significantly reduced LVMI after eight months, but amlodipine had less effect (16% vs. 1.2%, n = 50, p < 0.01). Formation of ROS by monocytes was reduced to a greater extent with valsartan than with amlodipine (28% vs. 2%, n = 50, p < 0.01). Valsartan but not amlodipine reduced CRP levels. A significant correlation between changes in ROS formation by monocytes and LVMI or between CRP and LVMI was observed.
CONCLUSIONS: The ARB valsartan has BP-independent effects on LVH, ROS formation by monocytes, and CRP in hypertensive patients with LVH.
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Abbreviations and Acronyms
| | ARB | = angiotensin receptor blocker | | ATII | = angiotensin II | | BP | = blood pressure | | CDCFH bis-AM ester | = carboxydichlorofluorescein diacetate bis-acetoxymethyl ester | | CRP | = C-reactive protein | | IL | = interleukin | | LV | = left ventricular | | LVH | = left ventricular hypertrophy | | LVMI | = left ventricular mass index | | ROS | = reactive oxygen species |
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