Effect on coronary flow velocity reserve in patients with type 2 diabetes mellitus: comparison between angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor antagonist.

Abstract

BACKGROUND:

The effects of angiotensin antagonists on coronary circulation in type 2 diabetes are unclear. We aimed to assess whether 4 weeks of treatment with angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist improves coronary flow velocity reserve (CFVR) in patients with type 2 diabetes.

METHODS:

Twenty-four asymptomatic patients with type 2 diabetes were randomly assigned to temocapril (2 mg/d) or candesartan (8 mg/d). Coronary flow velocity reserve, calculated as the ratio of adenosine-induced hyperemic to basal coronary flow velocity, was measured with transthoracic Doppler echocardiography. Coronary flow velocity reserve measurement and venous blood sampling were performed before and after 4 weeks of treatment. We also obtained CFVR and venous blood data in the 8 healthy controls.

RESULTS:

Coronary flow velocity reserve was significantly lower in patients than controls (temocapril group 2.74 +/- 0.28, candesartan group 2.65 +/- 0.30, controls 3.53 +/- 0.23, P < .0001 for both, respectively). Blood pressure was reduced in both diabetic groups (n = 12 each) similarly 4 weeks after treatment. There were no significant differences between the 2 groups in venous blood data before or after treatment. However, CFVR increased significantly in the temocapril group (2.74 +/- 0.28 to 3.31 +/- 0.36, P < .0001), but not in the candesartan group (2.65 +/- 0.30 to 2.71 +/- 0.43, P = ns).

CONCLUSIONS:

Coronary flow velocity reserve in patients with type 2 diabetes improved after treatment with temocapril but not with candesartan, suggesting that angiotensin-converting enzyme inhibitor, but not angiotensin II type 1 receptor antagonist, might have beneficial effects on coronary microangiopathy associated with type 2 diabetes.

• Authors: Takayuki Kawata, Masao Daimon, Rei Hasegawa, Kiyomi Teramoto, Tomohiko Toyoda, Tai Sekine, Kyohei Yamamoto, Daigaku Uchida, Toshiharu Himi, Katsuya Yoshida, Issei Komuro
• Journal: American heart journal (Am Heart J) Vol. 151 Issue 4 Pg. 798.e9-15 (Apr 2006) ISSN: 1097-6744 [Electronic] United States
• PMID: 16569537 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Benzimidazoles
• Biphenyl Compounds
• Tetrazoles
• Thiazepines
• temocapril hydrochloride
• candesartan

Topics

• Aged
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (pharmacology, therapeutic use)
• Benzimidazoles (therapeutic use)
• Biphenyl Compounds
• Blood Flow Velocity
• Coronary Circulation (drug effects)
• Diabetes Mellitus, Type 2 (physiopathology)
• Diabetic Angiopathies (drug therapy)
• Exercise Test
• Female
• Hemodynamics (drug effects)
• Humans
• Male
• Middle Aged
• Single-Blind Method
• Tetrazoles (therapeutic use)
• Thiazepines (therapeutic use)