Função diastólica e sua correlação com função endotelial em pacientes diabéticos tipo 2 hipertensos tratados com anlodipino associado a benazepril ou losartana

Abstract

Type 2 diabetic patients have increased risk of cardiovascular diseases, specially when there is associated arterial hypertension. Diastolic dysfunction is one of the first cardiac abnormalities in these patients and possibly endothelial dysfunction is involved on its pathophysiology Drugs that act on rennin-angiotensin system are important in treating diabetic patients and has favorable effects on diastolic and endothelial functions. There are few comparative studies of antihypertensive drugs effects over diastolic function in type 2 diabetic patients. The aim of this study was to compare combined therapy of amlodipine with losartan or benazepril effects over diastolic function in diabetic hypertensive patients and test the correlation between endothelial function, assessed by flow-mediated dilatation at brachial artery, with echocardiographic parameters of diastolic function. Thirty-four patients were randomized into two groups, 18 for the combination of losartan and amlodipine and 16 for benazepril with amlodipine, after a six weeks washout period only with anlodipine. At the time of randomization and after twelve weeks of combined therapy, the patients were submitted to clinical, laboratory and ultrasound evaluation. The groups showed left atrial indexed volume significant difference at the end of combined treatment period (losartan 30.2 ± 7.7 vs. benazepril 35.9 ± 8.0 ml/m², p: 0.044). There were no significant E/e ratio difference (losartan 8.97±1.59 vs benazepril 9.27±2.38, p: 0.589). There were correlation of flow-mediated dilatation with E/e ratio on echocardiography (r = -0.340, p = 0.043). The combined losartan-amlodipine therapy had a better effect on left atrial dimensions than combined benazepril-amlodipine therapy in type 2 diabetic hypertensive patients and that there was correlation between diastolic and endothelial function indexes in these patients.