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CLINICAL RESEARCH: CLINICAL TRIAL

Beneficial Effects of Valsartan in Asymptomatic Individuals With Vascular or Cardiac Abnormalities

The DETECTIV Pilot Study

Rasmussen Center for Cardiovascular Disease Prevention, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.

Manuscript received December 18, 2006; revised manuscript received February 28, 2007, accepted March 6, 2007.

^_* Reprint requests and correspondence: Dr. Daniel A. Duprez, Cardiovascular Division, VCRC-Room 270, Mayo Mail Code 508, University of Minnesota Medical School, 420 Delaware Street Southeast, Minneapolis, Minnesota 55455. (Email: dupre007{at}umn.edu).

Objectives: We studied the efficacy of valsartan (Val) to slow cardiovascular disease progression in asymptomatic high-risk prehypertensive or hypertensive patients with blood pressure (BP) controlled to <140/90 mm Hg and with evidence for functional or structural alterations in the cardiovascular system.

Background: Identifying individuals with early markers for cardiovascular disease raises the possibility for pharmacotherapy to slow progression and delay or prevent future morbid events.

Methods: Seventy-six subjects with a Rasmussen Disease Score (RDS) of 6 or higher were randomized double-blind to receive placebo (Plac) or Val 160 mg once daily for 6 months followed by 6 months of single-blind Val in both groups. A panel of 10 tests, including large and small artery elasticity, resting and treadmill exercise BP, carotid intimal-media thickness, retinal vascular photography, micro-albuminuria, electrocardiography, echocardiography, and plasma B-type natriuretic peptide, was performed at baseline and after 6 and 12 months of treatment. Each test result was scored as normal (0), borderline (1), or abnormal (2), and the total RDS was calculated by adding all the scores of the individual tests.

Results: Valsartan significantly reduced the RDS after 6 months versus Plac (p < 0.03) and at 12 months (either 12 or 6 months of Val, p < 0.0001). The major contribution in risk score reduction was due to an increase in small artery elasticity and a decrease in BP, and after 12 months there was a reduction in left ventricular mass index (p < 0.03).

Conclusions: Valsartan can slow progression and/or reverse early cardiovascular disease in asymptomatic high-risk patients with prehypertension or BP controlled to <140/90 mm Hg.

Abbreviations and Acronyms   ARB = angiotensin II receptor blocker   A/V = arteriole-to-venule   BP = blood pressure   C1 = large artery elasticity   C2 = small artery elasticity   CV = cardiovascular   DBP = diastolic blood pressure   LVMI = left ventricular mass index   Plac = placebo   RDS = Rasmussen Disease Score   SBP = systolic blood pressure   Val = valsartan

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