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European Journal of Echocardiography 2007 8(6):480-486; doi:10.1016/j.euje.2006.09.005
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Copyright © 2007, The European Society of Cardiology

Both ramipril and telmisartan reverse indices of early diabetic cardiomyopathy: A comparative study

Phivos Symeonidesa,*, Spyridon Koulourisb, Ekaterini Vratsistab, Konstantinos Triantafylloub, Georgios Ioannidisb, Nikolaos Thalassinosb and Demosthenes Katritsisa

aDepartment of Cardiology, Euroclinic Hospital, Athens, Greece
bFirst Cardiology Department and Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece

Received 10 August 2006; received in revised form 23 September 2006; accepted after revision 30 September 2006.

* Corresponding author. Markou Drakou 7, Pera Orinis, Nicosia, Cyprus P.C.: 2650. Tel.: +357 99381616. phisym{at}hotmail.com


  Abstract

Aims: We tested the hypothesis that renin–angiotensin system inhibition could reverse left ventricular diastolic dysfunction in patients with type 2 diabetes.

Methods and results: Forty asymptomatic patients with type 2 diabetes were recruited in this double-blind cross-over trial. Left ventricular diastolic function was assessed at baseline with Doppler echocardiography; ratios of early to late peak flow velocity through the mitral orifice (E/A) and velocity time integral of early to late transmitral diastolic flow (VTIE/VTIA) were evaluated. In addition, plasma brain natriuretic peptide (BNP) was measured.

Patients received randomly either ramipril (2.5mg/day), or telmisartan (40mg/day) or their combination for 3 months. Subsequently, every patient was crossed over to alternative regimens after a 2-week washout period. Measurements were repeated at the end of each treatment period.

Both E/A and VTIE/VTIA ratios were increased (29 and 20% with ramipril, 25 and 23% with telmisartan and 36 and 28% with combination treatment, respectively, p<0.001), whereas plasma BNP levels were significantly reduced with all 3 regimens (9% with ramipril, 25% with telmisartan and 36% with combination, p<0.001).

Conclusions: Both ramipril and telmisartan improve echocardiographic left ventricular diastolic indices and reduce plasma BNP levels in diabetic patients; their combination yields an even better therapeutic effect.

Keywords: Diabetic cardiomyopathy; Renin–angiotensin system blockade


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