Abstract 14536: Diastolic Function Parameters are Improved by the Addition of Simvastatin to Enalapril- Based Treatment in Hypertensive Patients: a Randomized Study
Background: Diastolic dysfunction (DD) is an increasingly frequent condition in hypertensive patients whose presence increases mortality and whose treatment remains unclear. The aim of this study was to investigate in a prospective, double-blinded, placebo-controlled randomized design the additive effect of simvastatin on enalapril on DD in hypertensive patients with average cholesterol levels.
Methods: We studied 54 hypertensive patients with DD, normal systolic function and LDL-cholesterol <160 mg/dL. Patients underwent a run-in phase to achieve systolic blood pressure (SBP) < 130 mmHg and diastolic blood pressure (DBP) < 85 mmHg with enalapril. Hydrochlorothiazide was added when need to achieve blood pressure control. Four weeks after reaching optimum anti-hypertensive regimen patients were randomly assigned to receive simvastatin 80 mg (27) or placebo (28) for a period of 20 weeks. Echocardiograms were performed before and after treatment with measurements of Left atrial volume (LAV) by modified Simpson's rule, conventional mitral Doppler velocities at early diastole (E) and late diastole (A) and Tissue Doppler velocities from mitral annulus at early (e′) and late diastole (a′).
Results: After 20 weeks, simvastatin group presented reduction in SBP (−4± mmHg; p=0.02) and a significant decrease in cholesterol (−47±31 mg/dl, p<0, 0001), LDL (−41± 28mg/dl, p<0. 0001) and triglycerides levels (−22. 8 ± 16 mg/dl, p=0.007) compared to placebo. E/A ratio increased significantly in simvastatin group compared to placebo (1±0.2 to 1.18 ± 0,3 for simvastatin; 1.06 ± 0.05 to 1.00 ± 0.05 for placebo; p=0.04) at the same time that LAV decreased (24.5 ± 0.9 ml/m2 to 21.1 ± 0.8 ml/m2 for simvastatin; 23.5 ± 1.0 ml/m2 to 23.2 ± 1.1 ml/m2 for placebo; p=0.04). No change in systolic function and no correlation between E/A ratio, LAV and changes in blood pressure or lipid profile were observed.
Conclusions: The addition of simvastatin to enalapril treatment in hypertensive patients with average cholesterol levels improves parameters of diastolic function independently of changes in blood pressure or cholesterol levels
- © 2010 by American Heart Association, Inc.