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Left ventricular hypertrophy (LVH) is one of the cardio-vascular risk factor in patients with hypertension and type 2 diabetes (T2D). The main role in development of LVH plays renin-angiotensin system (RAS). Angiotensin-(1-7) is the metabolic product of angiotensin-II and presents the cardioprotective part of RAS. Purpose The aim of the study was to evaluate the effect of combined treatment with angiotensin-II receptor blocker (ARB) olmesartan or angiotensin-converting enzyme inhibitor (ACEi) ramipril on levels of angiotensin-(1-7) and parameters of LVH in patients with hypertension and T2D. Methods The study involved 76 patients with hypertension grades 2–3 and T2D (37 men and 39 women) aged 43 to 70. The investigation included the echocardiography with determination of left ventricular mass index (LVMi). The LVH was determined according 2018 ESC/ESH Guidelines. The patients were randomized into two groups: group O - patients treated with ARB olmesartan (20–40 mg/day) and calcium channel blocker lercanidipine (10–20 mg/day) (n=38) and group R - patients who received ACEi ramipril (5–10 mg/day) with lercanidipine (10–20 mg/day) (n=38). All patients treated with lipid-lowering therapy (atorvastatin 20–40 mg/day) and antidiabetic therapy (metformin 1000–2000 mg/day) additionally. The angiotensin-(1-7) levels in the blood were determined by ELISA. Results Both groups did not differ significantly by angiotensin-(1-7) levels and parameters of LVH at baseline. After 12 months of the treatment in both groups there was powerful antihypertensive effect, which was not different depending on the combination of antihypertensive treatment. In the end of the treatment the levels of angiotensin-(1-7) were differed significantly only in patients of group O - there was increasing in its concentration by 20.3% (from 108.39 (92.32; 121.17) ng/l to (130.43 (124.42; 138.37) ng/l, p&amp;lt;0.01). In group R the levels of angiotensin-(1-7) were 112.09 (104.3; 115.33) ng/l, which were not significantly different from the baseline levels (p&amp;gt;0.05). In both groups there was significant improving of LVH after 12 month of the treatment – in O group LVMi reduced on 6.5% (p&amp;lt;0.01 vs baseline) and in in R group LVMi reduced on 6.3% (p&amp;lt;0.01 vs baseline). In patients with basal levels of angiotensin-(1-7) more than 105.51 ng/l both treatment reduced LVMi (−6.4% for olmesartan and −6.9% for ramipril). In patients with basal levels of angiotensin-(1-7) less than 105.51 ng/l only in the O group there was significant improving of LVH – reduction of LVMi on 6.8% (p&amp;lt;0.01 vs baseline). In R group changed of LVMi were not significant (p&amp;gt;0.5). Conclusions The using of ARB olmesartan, unlike ACEi ramipril, significantly increased angiotensin-(1-7) levels in hypertension diabetic patients. In patients with low levels of angiotensin-(1-7) the using of olmesartan, unlike ramipril, significantly reduced the LVMi and improved LVH, what can be used for differentiated choice of RAS blockers. Funding Acknowledgement Type of funding source: None

Olmesartan improves left ventricular hypertrophy in patients with hypertension and type 2 diabetes with low angiotensin-(1-7) blood levels