Astragalus Membranaceus Improving Asymptomatic Left Ventricular Diastolic Dysfunction in Postmenopausal Hypertensive Women with Metabolic Syndrome: A Prospective, Open-Labeled, Randomized Controlled Trial.

BACKGROUND: Postmenopausal women with metabolic syndrome (MetS) have increased cardiovascular morbidity and left ventricular diastolic dysfunction (LVDD). The various protective effects of astragalus membranaceus (AM) have been described in previous studies. Therefore, this study aimed to evaluate the effects of different doses of AM on diastolic function in postmenopausal hypertensive women with MetS. METHODS: This was a prospective, randomized controlled study. The postmenopausal hypertensive patients with MetS were enrolled from Lanzhou University Second Hospital from March 2014 to April 2015. Patients were divided into three groups: control group (received conventional medical treatment), AM Group 1 (received AM capsules at 5 g/d additionally), and AM Group 2 (received AM capsules at 10 g/d additionally). Echocardiographic and clinical characteristics were evaluated before and 12 months after treatment. Quantitative data were analyzed using unpaired t-test, analysis of variance, and multiple linear regression analysis. RESULTS: A total of 154 patients were subjected to final analysis. In the AM Group 2, significant improvements were noted in diastolic function 12 months after treatment than those of the control group, including the early diastolic mitral annular velocity (E'; 0.065 ± 0.007 m/s vs. 0.061 ± 0.008 m/s, P = 0.014), the ratio of the early diastolic mitral peak flow velocity to the late diastolic mitral peak flow velocity (E/A; 0.81 ± 0.05 vs. 0.80 ± 0.06, P = 0.012), the ratio of E' to the late diastolic mitral annular velocity (E'/A'; 0.56 ± 0.12 vs. 0.51 ± 0.13, P = 0.048), and the ratio of the early diastolic mitral peak flow velocity (E) to E' (E/E'; 10.70 ± 1.30 vs. 11.37 ± 1.73, P = 0.031). After treatment, E/E' (10.70 ± 1.30 vs. 11.24 ± 1.56, P = 0.021), deceleration time (DT; 261.49 ± 44.41 ms vs. 268.74 ± 53.87 ms, P = 0.046), and E'/A' (0.56 ± 0.12 vs. 0.52 ± 0.13, P = 0.019) values improved more significantly than those of AM Group 2 before treatment. Besides, waist circumference was positively correlated with E' (r = 0.472; P = 0.003) and E'/A' (r = 0.321; P = 0.047). In addition, the waist-to-hip ratio was a significant predictor of DT (r = 0.276; P = 0.041), E' (r = -0.590; P < 0.001), E/E' (r = 0.454; P = 0.004), and E'/A' (r = -0.377; P = 0.018). CONCLUSIONS: Conventional medical plus AM therapy improved diastolic function. Moreover, WC and WHR might be risk factors for LVDD. CHINESE CLINICAL TRIAL REGISTER: ChiCTR-TRC-11001747. http://www.chictr.org.cn/showprojen.aspx?proj=7798.

Features of left ventricular hypertrophy in patients with metabolic syndrome with or without comparable blood pressure: a meta-analysis.

The prevalence of metabolic syndrome (MS) has been on the rise over the past few decades, and this is associated with an increased incidence of target organ damage such as left ventricular hypertrophy (LVH). This meta-analysis aims to evaluate the features of LVH in MS patients with or without high blood pressure (BP). PubMed, Cochrane Library, Embase, Science Citation Index, and China Biology Medicine Disc, WanFang data, China National Knowledge Infrastructure database, and VIP were searched. Cross-sectional studies which directly compared LVH in hypertensive patients with MS and those with hypertension alone were identified. The following parameters were analyzed: systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular mass/height(2.7) (LVM/h(2.7)), interventricular septum thickness (IVSt), left ventricular end-diastolic diameter (LVEDd), left ventricular posterior wall (LVPW), ratio of early to late diastolic peak flow velocity (E/A), and relative wall thickness (RWT). Data were extracted and analyzed by Cochrane Collaboration's RevMan 5.0 software. 14 studies involving 5,994 patients were included. In four studies, MS patients with comparable level of BP had higher SBP (mmHg) [Mean Difference (MD) = 2.28, 95 % confidence intervals (CI): -0.58 to 5.13], DBP (mmHg) (MD = 1.32, 95 % CI: -0.23 to 2.87), LVM (g) (MD = 42.10, 95 % CI: 6.92-77.28), LVMI (g/m(2)) (MD = 8.93, 95 % CI: 5.29-12.57), LVM/h(2.7) (g/m(2.7)) (MD = 5.40, 95 % CI: 2.51-8.29), IVSt (mm) (MD = 0.49, 95 % CI: 0.28-0.71), LVEDd (mm) (MD = 1.04, 95 % CI: -1.10 to 3.18), LVPW (mm) (MD = 0.75, 95 % CI: 0.13-1.37), RWT (MD = 0.06, 95 % CI: -0.00 to 0.12), and lower E/A (MD = -0.08, 95 % CI: -0.18 to 0.02) when compared to the patients with hypertension alone. In other ten studies, the hypertensive patients with MS exhibited higher levels of SBP (mmHg) (MD = 4.67, 95 % CI: 2.72-6.62), DBP (mmHg) (MD = 2.03,95 % CI: 1.40-2.65), LVM (g) (MD = 24.79, 95 % CI: 20.21-29.36), LVMI(g/m(2)) (MD = 9.22, 95 % CI: 2.81-15.64), LVM/h(2.7) (g/m(2.7)) (MD = 5.97, 95 % CI: 4.14-7.80), IVSt (mm) (MD = 0.63, 95 % CI: 0.58-0.69), LVEDd (mm) (MD = 1.11, 95 % CI: 0.42-1.80), LVPW (mm) (MD = 0.63, 95 % CI: 0.31-0.94), RWT (MD = 0.02, 95 % CI: 0.01-0.03), as compared to patients with hypertension alone (P < 0.05). In addition, the MS patients combining with hypertension showed a lower E/A (MD = -0.07, 95 % CI: -0.10 to -0.04) when compared to those with hypertension alone. This study suggests that MS plays an important role in the development of LVH. MS seems to amplify hypertension-related cardiac changes. Furthermore, MS combining with higher level of BP will aggravate LVH and damage the diastolic function of left ventricle.

[Effect of different combined antihypertensive regimen on the erectile function in male hypertensive patients].

OBJECTIVE: To compare the effects of felodipine combined irbesartan regimen with that of felodipine combined metoprolol regimen on the sexual function in male hypertensive patients. METHOD: One hundred and twenty-three male hypertensive patients (age 25 to 60) were randomly assigned to felodipine (5 mg/d) plus irbesartan (150 mg/d, n = 64) group and felodipine (5 mg/d) plus metoprolol (47.5 mg/d, n = 59) group. Dosage of felodipine were doubled after 4 weeks if the blood pressure were > or = 140/ 90 mm Hg (1 mm Hg = 0.133 kPa). At the baseline and post 24th week treatment, sexual function of patients was assessed by the International Index of Erectile Function (IIEF) Questionaire. Serum testosterone (T), sex hormone binding globulin (SHBG), 4-hydroxynonenal (HNE), 8-hydroxy-2'-deoxyguanosine (8-OHdG) and Malonaldehyde (MDA) were measured by Radioimmunoassay (RIA), ELISA and TBA respectively. RESULTS: Total prevalence of erectile dysfunction (ED), T, SHBG and HNE were similar between pre- and post-treatment in two groups (P > 0.05). On the other hand, the scores of the mild ED and sexual desire (SD) were improved and both serum 8-OHdG and MDA in patients with ED decreased [(146.02 +/- 60.54) ng/L vs. (139.89 +/- 62.03) ng/L, P = 0.048 and (6.59 +/- 1.75) micromol/L vs. (5.51 +/- 1.65) micromol/L, P = 0.039] in Felodipine plus Irbesartan group. CONCLUSION: The results suggested that Felodipine + Irbesartan regimen may be superior to Felodipine + metoprolol regimen for male hypertensive patients with mild ED.