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Significant Reduction in Left Ventricular Mass Index, Reactive Oxygen Species Formation and C-Reactive Protein With Valsartan Treatment

Hypertensive patients with left ventricular hypertrophy who were treated with valsartan experienced reductions in left ventricular mass index and inflammatory markers such as reactive oxygen species formation by monocytes and c-reactive protein that were significantly greater compared to those treated with amlodipine, according to a new study.

Significant differences exist between the effects of valsartan, an angiotensin receptor blocker, and amlodipine, a calcium channel blocker, on left ventricular mass (LVM), C-reactive protein (CRP), and reactive oxygen species (ROS) formation by monocytes. These effects are not related to the effects the two drugs have on blood pressure (BP).

A team of Japanese investigators, led by Kenichi Yasunari, MD, PhD, Department of General Medicine and Cardiology, Graduate School of Medicine, Osaka, designed a cross-sectional and a prospective study to compare the effects of valsartan and amlodipine in 104 hypertensive patients with left ventricular hypertrophy (LVH).

Fifty-two patients were randomly assigned to 80 mg of valsartan and the remaining 52 to 5 mg of amlodipine for 8 months. The LVMI was calculated from echocardiograms. ROS formation by monocytes was measured from gated flow cytometry. In addition CRP and other pertinent blood parameters were obtained.

Despite very similar effects on BP, there was a significantly higher reduction in LVMI with valsartan compared with amlodipine (P < .001). The greater reduction in ROS formation by monocytes with valsartan compared with amlodipine was statistically significant (P < .01).

Analysis showed a significant correlation between the reduction in LVMI and the reduction in ROS formation by monocytes in the valsartan group (r = .61, P < .01), but not in the amlodipine group.

In the valsartan group, CRP levels were significantly reduced. There was no reduction in CRP levels in the amlodipine group. There was a significant correlation between the reduction in CRP and the reduction in LVMI in the valsartan group (r = .46, P < .01), but not in the amlodipine group. In the valsartan group, the correlation between the reduction in CRP and the decrease in ROS formation by monocytes was statistically significant (r = .38, P < .01). No correlation was observed in the amlodipine group.

"The ARB valsartan has BP-independent effects on LVH, ROS formation by monocytes, and CRP, in hypertensive patients with LVH," the authors concluded.

J Am Coll Cardiol 2004 Jun 2;43:11:2116-23 "Comparative effects of valsartan versus amlodipine on left ventricular mass and reactive oxygen species formation by monocytes in hypertensive patients with left ventricular hypertrophy"

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