ABSTRACT
It has been proposed that renin angiotensin system [RAS] plays a pivotal and perhaps obligatory role in the initiation and progression of ventricular hypertrophy. Glucose and insulin level are associated with left ventricular mass [LVM] in insulin resistant individuals. Antihypertensive drugs always have ditferent effects on glucose insulin levels, RAS and on LVM. To evaluate whether the effect of antihypertensives [Losartan or Ramipril] on LVM are associated with its effects on plasma glucose, insulin and aldosterone we compared their effects on these parameters in a group of insulin resistant, obese hypertensive patients. A total of 20 obese, non diabetic hypertensives who were 45 +/- 4 years had a body mass index of 31.5 +/- 2.5 Kg/m2, were free of coronary or valvular heart disease and had normal left ventricular [LV] function were randomized to treatment with losartan , 50mg daily [n=10]or ramipril 5 mg daily [n=10]. Echocardiograpic left ventricular mass [LVM] corrected for height [LVM/height] and plasma aldosterone [PA] were measured after 4 weeks of washout and 6 months of treatment. Baseline characteristics were similar in both groups. Losartan and ramipril effectively reduced blood pressure while both did not affect significantly fasting plasma glucose or insulin levels. Both ramipril and losartan significantly reduced LVM/ height. In obese hypertensive individuals adequate and similar blood pressure control was achieved with losartan and ramipril, also, in obese hypertensive patients both losartan and ramipril led to a significant regression of left ventricular mass associated with significant decreased plasma aldosterone level
ABSTRACT
Objective: flow associated dilatation [FXD%] and intima media thickness are established markers of early atherosclerosis. This study aimed to compare the ability of the non-invasive measurements FAD% and intima media thickness to predict coronary artery disease in asymptomatic diabetic males
Methods: B-mode ultrasonography was used to assess both intima media thickness in the common carotid artery and endothelial function in the brachial artery in 64 non-insulin dependent diabetic male patients asymptomatic for coronary artery disease. They were divided into two groups, Group A comprise patients with positive stress test, and group B patients with negative stress test. Brachial artery diameter was measured at rest, during reactive hyperemia, and after sublingual administration of nitroglycerin
Results: patients with positive exercise stress test had reduced FAD% compared with those with negative exercise stress test [4.4 +/- 0.67 v 5.8 +/- 1.1 5%. p<0.001], whereas intima media thick-ness tended to be increased in patients with positive exercise stress test but not statistically significant [1.1 +/- 0.16 v 0.96 +/- 0.0lmm, p > 0.05]. There was a negative correlation between FAD% and intima media thickness [r =-0.498, p <0.001]. Receiver operating character-istic analysis showed that FAD% > 4.6% predicted coronary artery disease with a sensitivity of 0.70 and a specificity of 0.87
Conclusions: brachial artery FMD may become a useful tool for screening diabetic male patients with suspected CALI while determination of increased intima media thickness is not useful in discrimina between presence or absence of coronary artery disease