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KMID : 0648320090150010016
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Journal of The Korean Society of Hypertension
2009 Volume.15 No. 1 p.16 ~ p.24
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Effects of Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker on Fibrinolysis and Left Ventricular Diastolic Function in Patients with Metabolic Syndrome
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Shin Mi-Seung
Kim Bong-Roung
Chung Wook-Jin
Bong Jeong-Min
Kang Woong-Chol
Han Seung-Hwan
Moon Chan-Il
Ahn Tae-Hoon
Choi In-Suck
Shin Eak-Kyun
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Abstract
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Background: The purpose of this study was to investigate the effects of angiotension converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) on blood pressure (BP), fibrinolysis, myocardial stiffness and left ventricular (LV) diastolic function in patients with metabolic syndrome.
Methods:Twenty four patients with metabolic syndrome were divided to two groups designed as cilazapril 5 mg or losartan 50 mg, administered daily for 12 weeks and then cross over studies after wash out period of 8 weeks. We measured BP and the plasma levels of PAI-1 and various biochemical parameters and calculated HOMA index. Transthoracic echocardiographies including tissue Doppler
imaging were done before and after treatment.
Results: Cilazapril improved HOMA index from 2.0 ¡¾ 1.0 to 1.3 ¡¾ 0.8 (p=0.02) and decreased systolic BP (p<0.05). LV early diastolic tissue velocity insignificantly increased and myocardial stiffness significantly decreased (p=0.048). Losartan insignificantly improved HOMA index but significantly reduced systolic and diastolic BP. LV posterior wall thickness significantly decreased (p=0.01) and LV early diastolic tissue velocity significantly increased. Myocardial stiffness insignificantly decreased and MCP-1 significantly decreased in losartan group. Plasma levels of PAI-1 showed no significant change after treatment in both groups.
Conclusion: Both cilazapril and losartan reduced BP in patients with metabolic syndrome. However, significant improvement of insulin resistance and myocardial stiffness was observed in cilazaparil group and significantly increased LV diastolic tissue velocity and reduced MCP-1 were observed in losartan group. The mechanisms seemed to be different between ACEI and ARB.
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KEYWORD
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Metabolic syndrome, Cilazapril, Losartan, Fibrinolysis, diastolic function
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