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Association of poor blood pressure control with incidence of stroke
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Abstracts
psychiatric disorders classification and diagnosis standard version 3 (CCND-3)”. Of 350, 120 patients have mental disorders (including 80 cases with depression, 35 patients with anxiety disorders, 5 cases with other types of mental disorder). Psychological evaluation and mental disorder psychological therapy (positive communication) were carried out for 120 cases. Among 120 patients, 95 patients had taken venlafaxine and alprazolam for 3 months. Results: After positive psychological treatment and medication, all patients can cooperate with treatment, reduced psychological stress, depression, agitated disappear or relieve symptoms. Finally symptoms in 18 cases (15%) were relieved, symptoms in 102 cases (85%) disappeared. Conclusion: Psychological therapy is an important part of treatment in stroke patients with mental disorders, and it is safe and effective.
doi:10.1016/j.ijcard.2011.08.507 0333 Increase in salivary cortisol in the evening correlates with sleep duration and quality in stroke patients SANGKWAN LEEa, MUNSOO KIMb, JONG-IN YOUNc, BONG-KEUN SONGa, KANG-KEYNG SUNGa a Department of Internal Medicine and Neuroscience, Oriental Medical School, Wonkwang University, 344-2, Shinyong-dong, Iksan, Chonbuk, Republic of Korea b Department of Psychology, Chonnam National University, 77 Yongbongro, Bukgu, Gwangju, Republic of Korea c Department of Biomedical Engineering, Catholic University of Daegu, 330 Geumrakri, Hayangeup, Gyeongsan, Gyeongbuk, Republic of Korea Objective: Although sleep disorder is commonly found in stroke patients, little is known about its mechanism. Recent research has provided evidence for an interaction between sleep and the activation of the hypothalamic–pituitary–adrenal axis. In particular, increased evening cortisol levels are correlated with sleep parameters. We examined whether the morning and evening cortisol levels differ between stroke patients and caregiver controls. Furthermore, we explored if the changes in cortisol secretion are related to the sleep disorder in stroke patients. Methods: We compared the cortisol levels of 35 admitted ischemic stroke patients with those of 25 age-matched caregiver controls who have cared for patients with other types of disease. Saliva samples for cortisol measurement were collected at 08:00 h and 20:00 h for 2 consecutive days and assayed using a modified radioimmunoassay. The patients were asked to estimate their own sleep quality using the Pittsburgh Sleep Quality Index (PSQI, lower scores meaning poorer sleep) and their caregivers were asked to measure the duration of nightly awakening of the patients. Results: Patients and controls did not differ in age, sex, body mass index, time of awakening or bedtime. Sleep duration decreased significantly in patients as compared to the controls (P b 0.05). Cortisol levels did not differ between the groups in the morning, but were higher in patients than in controls in the evening (P b 0.0001). Furthermore, evening cortisol levels of the patients were negatively correlated with sleep duration (r = − 0.51, P b 0.05) and PSQI scores (r = − 0.47, P b 0.05). Conclusions: Stroke patients showed higher than normal levels of cortisol secretion in the evening but not in the morning. Also, the evening cortisol levels correlated significantly with sleep disorder. These findings suggest that the disturbed HPA function and sleep disorder in stroke patients may be linked in such a way that they reinforce each other to form a vicious cycle. doi:10.1016/j.ijcard.2011.08.508
0336 Change in apparent temperature is associated with incidence of ischemic stroke SANGKWAN LEEa, MUNSOO KIMb, SOYEON KIMa, MIN-SOO KIMc, KANG-KEYNG SUNGa a Department of Internal Medicine and Neuroscience, Oriental Medical School, Wonkwang University, 344-2, Shinyong-dong, Iksan, Chonbuk, Republic of Korea b Department of Psychology, Chonnam National University, 77 Yongbongro, Bukgu, Gwangju, Republic of Korea c Department of Statistics, Chonnam National University, 77 Yongbongro, Bukgu, Gwangju, Republic of Korea Objective: Although several studies have reported significant relationship between incidence of ischemic stroke (IS) and changes in weather parameters occurring before IS onset, others failed to do so. We performed statistical modeling using a new meteorological factor, apparent temperature (AT) developed by Steadman, which is considered as a more reliable index for meteorological influences on human. Methods: All of the 466 patients (242 men and 224 women, mean age 67.7 years) who had been admitted to Wonkwang University Hospital due to IS attacks occurring between Oct 2006 and Oct 2008 participated in our study. We obtained meteorological data from the Korea Meteorological Administration and calculated the AT according to the following formula: AT=Ta+ 0.33×E −0.70×WS−4.00, where Ta is ambient temperature (°C), E humidity (hPa), and WS wind speed (m/s) at an elevation of 10 m. To examine the relationship between weather change and IS incidence, we used Poisson log-linear model in which log (μ/t)=α+βx, where μ is the expected number of patients and t a particular day. To predict IS incidence on a particular day, the amount of change in AT occurring between days 1 and 3 before IS onset was divided into three categories according to its maximum change: A≤2, 2b B≤4, and CN 4. Results: The number of days (patients) belonging to A, B, and C was 241 (133), 349 (207), and 170 (126), respectively. The log-linear model for the expected IS was log (μ/t)=0.7742 +0.1465x (χ2 =5.37, P=0.0205). Thus, as the amount of change in AT becomes larger from A to B or from B to C, IS incidence can increase 1.16 times. Conclusion: Weather change indexed by AT seems to be significantly associated with IS incidence. doi:10.1016/j.ijcard.2011.08.509 0344 Association of poor blood pressure control with incidence of stroke WEI WUa, QINGYING ZHANGa, YUNQUAN LINb Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China b Shantou Chaonan Minsheng Hospital, Shantou, Guangdong, China a
Objectives: The prevalence of hypertension in South China is increasing rapidly. Untreated hypertension results in stroke, and damage to major organs. This study aims to describe the association between poor blood pressure control and incidence of stroke. Methods: A case–control study was used in the study. Ninety three stroke patients (hypertensives:normotensives = 43:50) and 68 age and sex matched controls (hypertensives:normotensives = 17:51) were involved. We collected subjects receiving hypertension history, past hypertension management, recent blood pressure (BP) value. We compared the different prevalence of hypertension and different BP intervention strategies in subjects. Results: A significant difference was observed in both systolic and diastolic BP values between the stroke patients and healthy controls. The prevalence of hypertension in stroke patients (46.2%, 43/93) was significantly higher than controls
Abstracts
(25%, 17/68) (P = 0.006). After comparing the past hypertension management between stroke patients with hypertension and hypertensive controls, we found that a poor blood pressure control was strongly associated with incidence of stroke [P = 0.020; OR = 4.05 (95% CI= 1.204–13.619)]. Conclusions: Hypertension is the most important risk factor for all types of stroke. In patients with hypertension, prevention from stroke is the good management of BP. However, the ideal blood pressure target for prevention of stroke remains unclear. doi:10.1016/j.ijcard.2011.08.510 0348 Association of cerebral infarction with carotid atherosclerosis, triglycerides, C-reactive protein SHANGYING JIA Datong 322 Hospital, Datong, China Objective: To analyze the association of cerebral infarction with carotid atherosclerosis, triglycerides, C-reactive protein. Methods: We recruited 143 cerebral infarction patients, and 120 non-stroke patients as a control group. The carotid color dopplar ultrasound examination was done for all the patients. Lipids and C-reactive protein were measured. Results: The number of carotid atherosclerotic plaques detected was 107 in the stroke group, and 12 in the control group. Most plaques were located at the bifurcation of the carotid artery. Abnormal triglyceride proportion reached 55% (79 cases) in the stroke group, and 19% (23 persons) in the control group. The percentage of high C-reactive protein concentration was 42% (60 cases) and 13% (16 controls) for stroke and control groups, respectively. Conclusion: Cerebral infarction was closely related to the degree of carotid atherosclerosis, triglycerides and C-reactive protein. doi:10.1016/j.ijcard.2011.08.511
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Objective: The strong association between obstructive sleep apnea (OSA) and systemic hypertension (HT) is well recognized, previous studies have identified OSA as an independent predictor for sustained hypertension. Nevertheless, many patients with high blood pressure (BP) in the physician's office are normotensive elsewhere — this is so called white coat hypertension (WCH), which seems to occur in 24–39% of the general hypertensive population, but has rarely been described in patients with OSA. We aimed to determine the frequency of WCH in patients with OSA, and to analyze the characteristics of patients with WCH and OSA. Methods: 98 consecutive patients with OSA and 21 healthy control subjects were included in the study. Office BP and 24-h ambulatory BP monitoring (ABPM) were determined simultaneously with the polysomnographic study. BP variability and night BP will also be analyzed. Results: Office hypertension was diagnosed in 72 patients and normal BP in 26 (26.5%) patients with OSA. After ABPM, HT was confirmed in 42 patients (42.8%) with office hypertension and OSA, while WCH was diagnosed in the remaining 30 patients (30.6%). Compared to the control group, patients with OSA appear with greater BP standard deviation (SD) and coefficient of variation (CV) (P b 0.005, P b 0.001), especially those patients with WCH when compared to normotensive patients (P b 0.005, P b 0.001) or hypertensive patients with OSA (P b 0.005, P b 0.005). No-dipper BP also has higher frequency in patients with OSA than control group, but there are no differences between OSA groups. Conclusion: WCH is a frequent phenomenon in patients with OSA, which could lead to over-diagnosis of HT among these subjects. But WCH patients with OSA might represent a transitional state toward the development of persistent hypertension, and need to be noticed by us in the further development. doi:10.1016/j.ijcard.2011.08.513 0052 Calcium channel blocker-based combination regimen to prevent cardiac hypertrophy in patients with hypertension
Clinical Aspects 0029 Study of klotho protein in the pathogenesis of hypertension in elderly XIANMING SU, YAJUN HE, JINGWEI LIU, XIAOWEN ZHI The First Affiliated Hospital of Medicine School of Xi'an Jiaotong University, Xi'an, Shanxi, China Objective: We explored the mechanism of klotho protein in elderly patients with hypertension. Methods: Blood samples of 79 cases of senile hypertension and 25 cases of non-elderly hypertension and 30 cases of elderly non-hypertension were collected, and detected klotho protein and nitric oxide (NO) by ELISA and nitro-reductase methods. Results: Klotho protein and NO in elderly hypertensive absorbance were 0.303±0.096 and 43.95±21.85 μmol/L, less than the old non-hypertensive group (0.489±0.216 and 62.63±21.26 μmol/L), with a significant difference (Pb 0.01). Conclusion: Klotho protein reducing may be the main cause in the pathogenesis of hypertension in the elderly. doi:10.1016/j.ijcard.2011.08.512 0045 White coat hypertension in patients with obstructive sleep apnea LI LI, RUYANG NI, MINGYING WU Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, China
FENG ZHAO, JING YU, RUIXIN MA, LONGQUAN YANG, XIN LIN The Second Hospital of Lanzhou University, Lanzhou, Gansu, China Objectives: This clinical study is planned to investigate felodipine based combination of the antihypertensive drugs, that is whether felodipine plus irbesartan or plus metoprolol is superior to achieve the targeted blood pressure and prevent cardiomegaly in patients with uncomplicated hypertension. Methods: Fifty-eight patients (aged 18 to 60) with grade 1 and grade 2 uncomplicated hypertension (BP ≥140/90 mm Hg and b179/109 mm Hg) were assigned randomly to felodipine (5 mg q.d.) + irbesartan (150 mg q.d., F + I group, n = 28) group and felodipine (5 mg q.d.) + metoprolol (47.5 mg q.d., F + M group, n = 30) group. Target blood pressure is b140/90 mm Hg. Transthoracic echocardiography evaluation was performed. Left ventricular end-systolic dimension and left ventricular end-diastolic dimension (LVEDs, LVEDd) were measured and left ventricular mass (LVM) interventricular septum thickness (IST) and relative wall thickness (RWT) were calculated. All patients signed consent form and followed up for 48 weeks. The protocol was approved by the Ethic Committee of The Second Hospital of Lanzhou University. Results: The blood pressure between 2 groups was similar at the 4th, 8th, 24th and 48th weeks respectively (P N 0.05). The LVEDs and LVEDd were both smaller compared with baseline in F + I group and F + M group at 48th week follow-up (P b 0.05). The LVM and IST were also lesser compared with baseline both in F + I group and F + M group at 48th week (P b 0.05). The LVEDs and LVEDd were smaller in F + I group compared with those in F + M group at 48th week (P b 0.05). The LVM and IST were lesser in F + I group compared with those in F + M group at 48th week (P b 0.05). Conclusion: These
Abstracts
psychiatric disorders classification and diagnosis standard version 3 (CCND-3)”. Of 350, 120 patients have mental disorders (including 80 cases with depression, 35 patients with anxiety disorders, 5 cases with other types of mental disorder). Psychological evaluation and mental disorder psychological therapy (positive communication) were carried out for 120 cases. Among 120 patients, 95 patients had taken venlafaxine and alprazolam for 3 months. Results: After positive psychological treatment and medication, all patients can cooperate with treatment, reduced psychological stress, depression, agitated disappear or relieve symptoms. Finally symptoms in 18 cases (15%) were relieved, symptoms in 102 cases (85%) disappeared. Conclusion: Psychological therapy is an important part of treatment in stroke patients with mental disorders, and it is safe and effective.
doi:10.1016/j.ijcard.2011.08.507 0333 Increase in salivary cortisol in the evening correlates with sleep duration and quality in stroke patients SANGKWAN LEEa, MUNSOO KIMb, JONG-IN YOUNc, BONG-KEUN SONGa, KANG-KEYNG SUNGa a Department of Internal Medicine and Neuroscience, Oriental Medical School, Wonkwang University, 344-2, Shinyong-dong, Iksan, Chonbuk, Republic of Korea b Department of Psychology, Chonnam National University, 77 Yongbongro, Bukgu, Gwangju, Republic of Korea c Department of Biomedical Engineering, Catholic University of Daegu, 330 Geumrakri, Hayangeup, Gyeongsan, Gyeongbuk, Republic of Korea Objective: Although sleep disorder is commonly found in stroke patients, little is known about its mechanism. Recent research has provided evidence for an interaction between sleep and the activation of the hypothalamic–pituitary–adrenal axis. In particular, increased evening cortisol levels are correlated with sleep parameters. We examined whether the morning and evening cortisol levels differ between stroke patients and caregiver controls. Furthermore, we explored if the changes in cortisol secretion are related to the sleep disorder in stroke patients. Methods: We compared the cortisol levels of 35 admitted ischemic stroke patients with those of 25 age-matched caregiver controls who have cared for patients with other types of disease. Saliva samples for cortisol measurement were collected at 08:00 h and 20:00 h for 2 consecutive days and assayed using a modified radioimmunoassay. The patients were asked to estimate their own sleep quality using the Pittsburgh Sleep Quality Index (PSQI, lower scores meaning poorer sleep) and their caregivers were asked to measure the duration of nightly awakening of the patients. Results: Patients and controls did not differ in age, sex, body mass index, time of awakening or bedtime. Sleep duration decreased significantly in patients as compared to the controls (P b 0.05). Cortisol levels did not differ between the groups in the morning, but were higher in patients than in controls in the evening (P b 0.0001). Furthermore, evening cortisol levels of the patients were negatively correlated with sleep duration (r = − 0.51, P b 0.05) and PSQI scores (r = − 0.47, P b 0.05). Conclusions: Stroke patients showed higher than normal levels of cortisol secretion in the evening but not in the morning. Also, the evening cortisol levels correlated significantly with sleep disorder. These findings suggest that the disturbed HPA function and sleep disorder in stroke patients may be linked in such a way that they reinforce each other to form a vicious cycle. doi:10.1016/j.ijcard.2011.08.508
0336 Change in apparent temperature is associated with incidence of ischemic stroke SANGKWAN LEEa, MUNSOO KIMb, SOYEON KIMa, MIN-SOO KIMc, KANG-KEYNG SUNGa a Department of Internal Medicine and Neuroscience, Oriental Medical School, Wonkwang University, 344-2, Shinyong-dong, Iksan, Chonbuk, Republic of Korea b Department of Psychology, Chonnam National University, 77 Yongbongro, Bukgu, Gwangju, Republic of Korea c Department of Statistics, Chonnam National University, 77 Yongbongro, Bukgu, Gwangju, Republic of Korea Objective: Although several studies have reported significant relationship between incidence of ischemic stroke (IS) and changes in weather parameters occurring before IS onset, others failed to do so. We performed statistical modeling using a new meteorological factor, apparent temperature (AT) developed by Steadman, which is considered as a more reliable index for meteorological influences on human. Methods: All of the 466 patients (242 men and 224 women, mean age 67.7 years) who had been admitted to Wonkwang University Hospital due to IS attacks occurring between Oct 2006 and Oct 2008 participated in our study. We obtained meteorological data from the Korea Meteorological Administration and calculated the AT according to the following formula: AT=Ta+ 0.33×E −0.70×WS−4.00, where Ta is ambient temperature (°C), E humidity (hPa), and WS wind speed (m/s) at an elevation of 10 m. To examine the relationship between weather change and IS incidence, we used Poisson log-linear model in which log (μ/t)=α+βx, where μ is the expected number of patients and t a particular day. To predict IS incidence on a particular day, the amount of change in AT occurring between days 1 and 3 before IS onset was divided into three categories according to its maximum change: A≤2, 2b B≤4, and CN 4. Results: The number of days (patients) belonging to A, B, and C was 241 (133), 349 (207), and 170 (126), respectively. The log-linear model for the expected IS was log (μ/t)=0.7742 +0.1465x (χ2 =5.37, P=0.0205). Thus, as the amount of change in AT becomes larger from A to B or from B to C, IS incidence can increase 1.16 times. Conclusion: Weather change indexed by AT seems to be significantly associated with IS incidence. doi:10.1016/j.ijcard.2011.08.509 0344 Association of poor blood pressure control with incidence of stroke WEI WUa, QINGYING ZHANGa, YUNQUAN LINb Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China b Shantou Chaonan Minsheng Hospital, Shantou, Guangdong, China a
Objectives: The prevalence of hypertension in South China is increasing rapidly. Untreated hypertension results in stroke, and damage to major organs. This study aims to describe the association between poor blood pressure control and incidence of stroke. Methods: A case–control study was used in the study. Ninety three stroke patients (hypertensives:normotensives = 43:50) and 68 age and sex matched controls (hypertensives:normotensives = 17:51) were involved. We collected subjects receiving hypertension history, past hypertension management, recent blood pressure (BP) value. We compared the different prevalence of hypertension and different BP intervention strategies in subjects. Results: A significant difference was observed in both systolic and diastolic BP values between the stroke patients and healthy controls. The prevalence of hypertension in stroke patients (46.2%, 43/93) was significantly higher than controls
Abstracts
(25%, 17/68) (P = 0.006). After comparing the past hypertension management between stroke patients with hypertension and hypertensive controls, we found that a poor blood pressure control was strongly associated with incidence of stroke [P = 0.020; OR = 4.05 (95% CI= 1.204–13.619)]. Conclusions: Hypertension is the most important risk factor for all types of stroke. In patients with hypertension, prevention from stroke is the good management of BP. However, the ideal blood pressure target for prevention of stroke remains unclear. doi:10.1016/j.ijcard.2011.08.510 0348 Association of cerebral infarction with carotid atherosclerosis, triglycerides, C-reactive protein SHANGYING JIA Datong 322 Hospital, Datong, China Objective: To analyze the association of cerebral infarction with carotid atherosclerosis, triglycerides, C-reactive protein. Methods: We recruited 143 cerebral infarction patients, and 120 non-stroke patients as a control group. The carotid color dopplar ultrasound examination was done for all the patients. Lipids and C-reactive protein were measured. Results: The number of carotid atherosclerotic plaques detected was 107 in the stroke group, and 12 in the control group. Most plaques were located at the bifurcation of the carotid artery. Abnormal triglyceride proportion reached 55% (79 cases) in the stroke group, and 19% (23 persons) in the control group. The percentage of high C-reactive protein concentration was 42% (60 cases) and 13% (16 controls) for stroke and control groups, respectively. Conclusion: Cerebral infarction was closely related to the degree of carotid atherosclerosis, triglycerides and C-reactive protein. doi:10.1016/j.ijcard.2011.08.511
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Objective: The strong association between obstructive sleep apnea (OSA) and systemic hypertension (HT) is well recognized, previous studies have identified OSA as an independent predictor for sustained hypertension. Nevertheless, many patients with high blood pressure (BP) in the physician's office are normotensive elsewhere — this is so called white coat hypertension (WCH), which seems to occur in 24–39% of the general hypertensive population, but has rarely been described in patients with OSA. We aimed to determine the frequency of WCH in patients with OSA, and to analyze the characteristics of patients with WCH and OSA. Methods: 98 consecutive patients with OSA and 21 healthy control subjects were included in the study. Office BP and 24-h ambulatory BP monitoring (ABPM) were determined simultaneously with the polysomnographic study. BP variability and night BP will also be analyzed. Results: Office hypertension was diagnosed in 72 patients and normal BP in 26 (26.5%) patients with OSA. After ABPM, HT was confirmed in 42 patients (42.8%) with office hypertension and OSA, while WCH was diagnosed in the remaining 30 patients (30.6%). Compared to the control group, patients with OSA appear with greater BP standard deviation (SD) and coefficient of variation (CV) (P b 0.005, P b 0.001), especially those patients with WCH when compared to normotensive patients (P b 0.005, P b 0.001) or hypertensive patients with OSA (P b 0.005, P b 0.005). No-dipper BP also has higher frequency in patients with OSA than control group, but there are no differences between OSA groups. Conclusion: WCH is a frequent phenomenon in patients with OSA, which could lead to over-diagnosis of HT among these subjects. But WCH patients with OSA might represent a transitional state toward the development of persistent hypertension, and need to be noticed by us in the further development. doi:10.1016/j.ijcard.2011.08.513 0052 Calcium channel blocker-based combination regimen to prevent cardiac hypertrophy in patients with hypertension
Clinical Aspects 0029 Study of klotho protein in the pathogenesis of hypertension in elderly XIANMING SU, YAJUN HE, JINGWEI LIU, XIAOWEN ZHI The First Affiliated Hospital of Medicine School of Xi'an Jiaotong University, Xi'an, Shanxi, China Objective: We explored the mechanism of klotho protein in elderly patients with hypertension. Methods: Blood samples of 79 cases of senile hypertension and 25 cases of non-elderly hypertension and 30 cases of elderly non-hypertension were collected, and detected klotho protein and nitric oxide (NO) by ELISA and nitro-reductase methods. Results: Klotho protein and NO in elderly hypertensive absorbance were 0.303±0.096 and 43.95±21.85 μmol/L, less than the old non-hypertensive group (0.489±0.216 and 62.63±21.26 μmol/L), with a significant difference (Pb 0.01). Conclusion: Klotho protein reducing may be the main cause in the pathogenesis of hypertension in the elderly. doi:10.1016/j.ijcard.2011.08.512 0045 White coat hypertension in patients with obstructive sleep apnea LI LI, RUYANG NI, MINGYING WU Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, China
FENG ZHAO, JING YU, RUIXIN MA, LONGQUAN YANG, XIN LIN The Second Hospital of Lanzhou University, Lanzhou, Gansu, China Objectives: This clinical study is planned to investigate felodipine based combination of the antihypertensive drugs, that is whether felodipine plus irbesartan or plus metoprolol is superior to achieve the targeted blood pressure and prevent cardiomegaly in patients with uncomplicated hypertension. Methods: Fifty-eight patients (aged 18 to 60) with grade 1 and grade 2 uncomplicated hypertension (BP ≥140/90 mm Hg and b179/109 mm Hg) were assigned randomly to felodipine (5 mg q.d.) + irbesartan (150 mg q.d., F + I group, n = 28) group and felodipine (5 mg q.d.) + metoprolol (47.5 mg q.d., F + M group, n = 30) group. Target blood pressure is b140/90 mm Hg. Transthoracic echocardiography evaluation was performed. Left ventricular end-systolic dimension and left ventricular end-diastolic dimension (LVEDs, LVEDd) were measured and left ventricular mass (LVM) interventricular septum thickness (IST) and relative wall thickness (RWT) were calculated. All patients signed consent form and followed up for 48 weeks. The protocol was approved by the Ethic Committee of The Second Hospital of Lanzhou University. Results: The blood pressure between 2 groups was similar at the 4th, 8th, 24th and 48th weeks respectively (P N 0.05). The LVEDs and LVEDd were both smaller compared with baseline in F + I group and F + M group at 48th week follow-up (P b 0.05). The LVM and IST were also lesser compared with baseline both in F + I group and F + M group at 48th week (P b 0.05). The LVEDs and LVEDd were smaller in F + I group compared with those in F + M group at 48th week (P b 0.05). The LVM and IST were lesser in F + I group compared with those in F + M group at 48th week (P b 0.05). Conclusion: These