Effect of the angiotensin receptor blocker Valsartan on coronary microvascular flow reserve in moderately hypertensive patients with stable coronary artery disease

Microcirculation. Nov-Dec 2007;14(8):805-12. doi: 10.1080/10739680701410827.

Abstract

Aims: To noninvasively investigate the effects of the angiotensin receptor blocker (ARB) Valsartan. on myocardial microcirculation in moderately hypertensive patients with stable coronary artery disease (CAD).

Methods and results: In this prospective open-label study, patients with mild stable CAD and moderate systolic and/or diastolic hypertension were treated with 160 mg Valsartan daily. Myocardial blood flow was quantified noninvasively using positron emission tomography (PET) with N-13 ammonia at baseline, after one week and after 16 weeks. Mean blood pressure at rest improved significantly from baseline to week 16 (105 +/- 10 vs. 98 +/- 9 mm Hg: p = 0.017, n = 12), but no significant change was observed after one week (103 +/- 11 vs. 100 +/- 11, p = 0.43, n = 13). PET analysis revealed that flow increase during endothelial-dependent, sympathetic stimulation by cold pressor testing (CPT) and in response to pharmacologic vasodilation with adenosine improved from baseline after 1 week (CPT: 1.10 +/- 0.3 vs. 1.37 +/- 0.3; p = 0.017, adenosine: 2.34 +/- 0.52 vs. 2.91 +/- 0.81; p = 0.048) and at week 16 (CPT: 1.15 +/- 0.4 vs 1.39 +/- 0.2; p = 0.10, adenosine: 2.34 +/- 0.52 vs 2.81 +/- 0.91; p = 0.039).

Conclusions: In patients with stable coronary disease, ARB results in improved PET-determined microvascular flow reserve. Improvements in microcirculation preceded the reduction of blood pressure, suggesting direct beneficial effects on microvascular function.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiotensin II Type 1 Receptor Blockers / administration & dosage*
  • Antihypertensive Agents / administration & dosage
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / drug therapy
  • Coronary Artery Disease / physiopathology*
  • Female
  • Fractional Flow Reserve, Myocardial / drug effects*
  • Humans
  • Male
  • Microcirculation / drug effects
  • Middle Aged
  • Positron-Emission Tomography
  • Prospective Studies
  • Radiography
  • Tetrazoles / administration & dosage*
  • Valine / administration & dosage
  • Valine / analogs & derivatives*
  • Valsartan

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Antihypertensive Agents
  • Tetrazoles
  • Valsartan
  • Valine