Effect of renin-angiotensin-aldosterone system blockers on left ventricular remodeling in patients with arterial hypertension: valsartan and perindopril therapy

Arterial hypertension (AH) often leads to left ventricular (LV) remodeling, increasing cardiovascular risk. The role of renin-angiotensin-aldosterone system (RAAS) blockers in the regression of LV pathological changes requires further clarification. Objective: The aim of the study is to evaluate the effect of valsartan and perindopril on the dynamics of LV geometry in patients with newly diagnosed arterial hypertension. Materials and Methods. The study included 44 patients with stage 2 arterial hypertension without chronic diseases that could cause cardiac remodeling. All participants underwent echocardiography before treatment and 6 months after antihypertensive therapy, provided that the target blood pressure level was achieved. To assess the type of remodeling, LV myocardial mass index (LVMI) and LV relative wall thickness (RWT) were determined. Patients were divided into 2 groups: those taking perindopril (n=22) and those taking valsartan (n=22). Statistical processing was performed using the paired Student's t-test (p≤0.05). Results. Initially, concentric LV changes predominated: left ventricular concentric remodeling (LVCR) – 47 %, left ventricular concentric hypertrophy (LVCH) – 37 %. During valsartan therapy, LVCH transformed into LVCR in 50 % of patients with LVCH. Moreover, normalization of LV geometry was observed in 40 % of patients with LVCR. In the perindopril group, transition from LVCH to LVCR was observed in 38 % of patients. However, LVCR transformed to normal left ventricular geometry (NLVG) only in 10 % of patients. LVMI and LV RWT dynamics were statistically significant (p˂0.05). Conclusion. RAAS blockers promote regression of LV hypertrophy, but valsartan is presumably superior to perindopril in efficacy in LV concentric remodeling. The results of the study confirm the advisability of a differentiated approach to the choice of RAAS blockers depending on the type of LV remodeling.