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Effect of the Angiotensin Receptor Blocker Valsartan on Coronary Microvascular Flow Reserve in Moderately Hypertensive Patients with Stable Coronary Artery Disease
Author(s) -
Higuchi Takahiro,
Abletshauser Claudia,
Nekolla Stephan G.,
Schwaiger Markus,
Bengel Frank M.
Publication year - 2007
Publication title -
microcirculation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.793
H-Index - 83
eISSN - 1549-8719
pISSN - 1073-9688
DOI - 10.1080/10739680701410827
Subject(s) - valsartan , medicine , cardiology , coronary artery disease , microcirculation , coronary flow reserve , vasodilation , angiotensin receptor , blood pressure , coronary circulation , angiotensin ii , blood flow , adenosine
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.