The angiotensin 1-7 blood levels decreasing in the patients with arterial hypertension and type 2 diabetes is associated with the development of the hypertensive heart disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Angiotensin 1-7 (Ang-(1–7) - one of the components of the renin-angiotensin system, is the main counterparty of Аngiotensin II (AII). It implements protective effects opposite to the action of AII. Ang-(1–7) induces vasodilatory, anti-inflammatory, antifibrotic, antiangiogenic and antihypertensive effects. Alterations in left ventricle (LV) geometry such as LV dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the mechanisms are still not well-understood in patients with arterial hypertension (AH) and type 2 diabetes (T2D) The aim of the work was to study the Ang-(1–7) levels in blood plasma of patients with arterial hypertension (AH) with hypertensive heart disease (HHD) and concomitant T2D. Methods A total of 70 patients with grade 2–3 AH and HHD with concomitant T2D aged 42 to 69 years (48 patients had LV diastolic dysfunction (DD) and 22 patients had normal LV diastolic function) and 20 practically healthy individuals of comparable gender and age were examined. The survey included standard clinical, laboratory and instrumental methods. Diagnosis of AH and HHD was carried out according to the 2018 ESC/ESH recommendations. LV DD was determined according to the 2016 ASE/EACVI recommendations. The blood levels of Ang-(1–7) were determined by the enzyme immunoassay. Results We have found that in patients with AH and T2D plasma Ang-(1–7) levels were significantly lower than in practically healthy individuals – 105,51(89,13;121,17) ng/l versus 128,77(120,02;276,49) ng/l, p<0,05. Among patients with АН and T2D the following types of l LV ventricular remodeling were identified: 35 patients had concentric LV hypertrophy, 25 patients had eccentric LV hypertrophy, 10 patients had concentric remodeling of LV. The patients with concentric LV hypertrophy and eccentric LV hypertrophy had significant lower levels of Ang-(1-7) than in patients with concentric remodeling of LV - 107,5(88,2;119,6) ng/l and 101,4(84,2;111,8) ng/l versus 129,3(117,5;136,8) ng/l (р<0,01 and р<0,01 respectively) but did not differ between themselves (p<0,05). In all this among patients with LV DD levels of Ang-(1-7) were significantly lower than in patients with normal diastolic function - 101,1(87,9;116,6) ng/l versus 121,1(105,5;128,9) ng/l, р<0,01. In the in patients with AH and T2D there was a statistically significant negative relationship between plasma Ang-(1-7) level and next LV parameters: LV mass index (R = −0.41, p < 0.001 and LV mass (R=-0,40, p<0,001). Conclusion The findings suggest the significant role of decreased Ang-(1-7) levels in blood plasma of patients with AH and concomitant T2D in the development and progression of HHD.