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Detecting left ventricular dysfunction and lowering blood pressure in hypertensive patients with diabetes mellitus.

Niels Holmark Andersen 

Summary

The aim of the thesis was first of all to explore the possibilities of an chocardiographic and a biochemical marker of left ventricular dysfunction in hypertensive patients with diabetes.

By use of an echocardiographic method (myocardial performance index (MPI)) of quantifying the left ventricular function, we found significantly reduced left ventricular function in 45 hypertensive patients with diabetes compared to a matched control group of non-diabetic individuals, but a similar reduction in LV function in 45 patients with essential hypertension.

The method disclosed a reduction of the diastolic performance being causal to the reduction in left ventricular function among the diabetic patients, whereas the systolic function was involved in the reduction of the left ventricular function in the essential hypertensive group. These findings were seen despite al included participants had a normal left ventricular ejection fraction and no cardiac symptoms. Estimation of the MPI   during a routine echocardiography will provide new information in hypertensive patients,   beyond what is provided from more difficult echocardiographic procedures.  

In the second study the brain natriuretic peptide (NT-proBNP) levels of 30   normotensive and 30 hypertensive type 2 diabetic patients were compared to a matched   normal group, with relation to echocardiographic assessment of left ventricular geometry,   hypertrophy and the diastolic function. The NT-proBNP levels were significantly increased   in hypertensive, normoalbuminuric patients with type 2 diabetes. These findings were   related to the presence of left ventricular hypertrophy and increased left atrial and   ventricular diameters, but not directly related to the diastolic function. NT-proBNP   seemed likely to be a solid indicator of patients with cardiovascular risk markers but not   directly related to the LV function per se.  

In the third study, 75 patients with hypertension and diabetes mellitus were   enrolled in a randomised double blind study, investigating the blood pressure lowering   abilities of either lisinopril 40 mg o.d or dual blockade treatment with candesartan 16 mg   o.d and lisinopril 20 mg o.d. Significant blood pressure reduction was obtained in both   treatment arms (24 hour systolic blood pressure (dual blockade 6 mmHg versus lisinopril 2   mmHg), but no significant difference was found between dual blockade and high dosage   lisinopril (p= 0.10). Both treatments were generally well tolerated and similar low rates of   side effects were found in the two groups.