USEFULNESS OF BPN LEVELS IN IDENTIFYING DIABETIC HYPERTENSIVES WITH SYSTOLIC-DIASTOLIC LEFT VENTRICULAR DYSFUNCTION. ABILITY OF THE ANGIOTENSIN II INHIBITOR TO CONVERT IT BACK

Objective: We tested the hypothesis that the renin-angiotensin system could convert left ventricular diastolic dysfunction in patients with type 2 diabetes. Design and method: Fifty asymptomatic patients with type 2 diabetes were recruited in this double-blind cross-over trial. Baseline left ventricular diastolic function was assessed with Doppler echocardiography; using velocity ratios of peak flow through the mitral orifice (E/A) and the integral velocity of before end diastolic transmitral flow (VTIE/VTIA). In addition, plasma brain natriuretic peptide (BNP) levels were measured. Patients randomly received either zofenopril (15mg/day), or Olmesartan (10mg/day) or their combination for 3 months and each time after a 2-week washout period. Measurements were repeated at the end of each treatment period. Results: Both E/A and VTIE/VTIA ratios increased (29 and 20% with zofenopril, 25 and 23% with olmesartan, and 36 and 28% with combination treatment, respectively, p < 0.001), while levels plasma BNP levels were significantly reduced with all 3 regimens (9% with zofenopril, 25% with olmesartan, and 36% with combination, p < 0.001). Conclusions: Both olmesartan and zofenopril improve left ventricular diastolic echocardiographic indices and reduce plasma BNP levels in diabetic patients, their combination produces an even better therapeutic effect.