Beneficial effects of telmisartan on left ventricular structure and function in patients with hypertension determined by two-dimensional strain imaging

Abstract

Telmisartan is an angiotensin II receptor blocker with established beneficial effects on cardiac structure and function in animal models. Our aim was to clinically clarify the cardiprotective ability, beyond lowering blood pressure (BP), of telmisartan on left ventricular (LV) myocardial mechanics in patients with hypertension using a two-dimensional (2-D) strain imaging. Telmisartan (20-40 mg daily) was administered to 35 previously untreated patients with hypertension. Conventional and 2-D strain echocardiography were performed after medication had been continued for 1-2 months with values of systolic BP less than 140 mmHg and diastolic BP less than 90 mmHg (phase I) and for 12 months (phase II) in all patients and 30 age-matched normal individuals. There were no differences in BP, LV ejection fraction, and ratio of peak early to late diastolic transmitral flow velocity (E/A) between phases I and II of hypertension group and normal group. In phase I, the mean peak systolic strains and strain rates in the longitudinal and circumferential directions, mean peak early diastolic strain rates in the longitudinal, circumferential, and radial directions, and mean peak atrial systolic strain rate in the longitudinal direction were lower than those in the normal group. In phase II, the LV mass index, relative LV wall thickness, isovolumic relaxation time, torsion and torsional rate were decreased, whereas the mean peak systolic strains and early diastolic strain rates in all the three directions, mean peak systolic strain rates in the longitudinal and circumferential directions, and mean peak atrial systolic strain rate in the longitudinal direction were increased compared with phase I. The use of telmisartan in patients with hypertension improved not only LV geometric remodeling but also regional LV myocardial contraction and relaxation in the three directions, especially longitudinal and circumferential directions. Our results support beneficial effects on LV structure and function beyond BP reduction from continuous long-term telmisartan therapy.