Treatment with calcium antagonist does not increase exercise tolerance in essential hypertensives with latent heart failure

Abstracts

Methods: 135 coronary heart disease patients (pts), complicated by heart failure (HF) III–IY functional class (FC) and pulmonary hypertension (PH) were surveyed. EchoCG, bicycle test, flow mediated dilation (FMD) of the brachial artery and circulating markers of endothelial function (EF) were collected. The 1st group was treated with nebivolol, the 2nd group — bisoprolol, and the 3rd group — eprosartan and bisoprolol during 6 months. Results: Systolic and diastolic function of LV, tolerance to physical exercise and life quality improved in the 1st group. Pulmonary artery systolic pressure (PASP) decreases in the moderate PH subgroup from 42.17 ± 5.1 to 31.7± 8.4 (p = 0.002) during 6 months. EF improvement was noted according to FMD and biochemical indices. Improvements in intracardiac haemodynamics and EF were noted in the 2nd group. PASP decreased in pts with moderate PH (from 40.4 ± 3.1 to 28.5 ± 8.5 mm Hg) (p = 0.000); in the subgroup with expressed increase in PASP only the tendency to decrease in PH was noted. In the 3rd group — initially 78% pts had expressed PH 48 ± 7.7 mm Hg. PASP decreased in pts with moderate PH (from 41.4 ± 2.1 mm Hg up to 29.7 ± 8.5 mm Hg (p = 0.032)) and in pts with expressed increase in PASP (from 52.4 ± 3.1 mm Hg to 37.6 ± 4.5 mm Hg (p = 0.04). Conclusions: If ACE inhibitors and BAB for treatment of HF with PH are used without effect, eprosartan can be used for decrease in PASP as part of a comprehensive therapy for HF. The important circumstance is that comprehensive therapy with bisoprolol and eprosartan is effective in pts with HF III–IY FC and with moderate and, what is particularly essential, with expressed pulmonary hypertension. doi:10.1016/j.ijcard.2007.03.048

P34 Treatment with calcium antagonist does not increase exercise tolerance in essential hypertensives with latent heart failure Dace Matisone, University of Latvia, Riga, Latvia, Indulis Kukulis, University of Latvia, Riga, Latvia, Vilnis Dzerve, University of Latvia, Riga, Latvia Objective: To ascertain if effective treatment with verapamil influences exercise tolerance in essential hypertensives. Methods: 36 essential hypertensives (WHO II) aged between 38 and 67 years received a 2-month treatment with verapamil in effective dosage (240–360 mg daily). Blood pressure (BP) was determined auscultatory. Cardiac output (CO), stroke volume (SV), ejection fraction (EF) and systemic vascular resistance (SVR) were derived from echocardiographic findings. A cycle exercise was performed with a stepwise increase of the load by 25 W every 3 min until patient reached submaximal pulse or other indications appeared for cessation of the exercise. All determined parameters and cycle ergometer test were performed before and after the 2 month treatment. Results: Verapamil was found to produce a significant reduc-

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tion in systolic (−18.8 ± 1.9 mm Hg), diastolic (−8.7 ± 1.2 mm Hg), mean (−13.7 ± 1.6 mm Hg) and pulse (−12.5 ± 1.5 mm Hg) pressure. All patients could be divided into two groups: in group 1 (n = 20) the hypotensive effect was caused by a decrease in CO, mainly as a result of reduction in heart rate (HR), and in group 2 (n = 16) — by a decrease in SVR which was accompanied by a significant increase in SV, EF and CO without the increase in HR. The mean values of maximal load, exercise duration and double product of HR and BP in both groups did not change after treatment. Conclusion: Exercise tolerance is a result of multifactorial consequences, the increase in CO alone does not increase exercise tolerance in essential hypertensives even with latent heart failure. doi:10.1016/j.ijcard.2007.03.049

P35 B-type natriuretic peptide predicting exercise tolerance in patients with coronary heart disease Regina Grybauskiene, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania, Dovile Karciauskaite, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania, Zita Bertasiene, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania, Grazina Urbonaviciene, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania, Jurate Janenaite, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania, Pranas Grybauskas, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania Objective: To analyse whether resting B-type natriuretic peptide (BNP) can predict functional capacity (FC) in patients (p) with coronary heart disease (CHD). Patients and methods: 57 p (group I—36 p 2–3 years after myocardial infarction; group II—21 p 3–4 years after CABG+ reconstructive mitral valve surgery) were enrolled to perform exercise test (ExT). BNP levels were measured (Triage BNP assay, Biosite Diagnostics, Inc. Ref. level −50 pg/ml) at rest and after peak exercise, peak exercise BNP/total workload ratio was calculated. The bicycle ExT was performed from 50 W increasing the load every 2 min 25 W until submaximal load or limiting symptoms. Echocardiographic parameters were measured and left ventricle (LV) was taken dilated when LVEDD/ body surface area N 30 mm/m2. Results: Resting BNP was markedly higher in p with dilated LV (p = 0.015). Peak exercise BNP/total workload ratio was higher in group II (p b 0.05). Significant correlations were found between resting BNP and age (r = 0.3805; p = 0.013), LV ejection fraction (r = −0.383; p = 0.012), LV systolic volume (r = 0.353; p = 0.022), and LV myocardial mass (0.34; p = 0.028) for group I. The odds ratio for achieved workload b100 W was 4.25; p = 0.034; 95% CI [1.05; 17.2] when resting BNP more than 135 pg/ml. The prognostic accuracy of resting BNP for achieving total workload N 100 W was defined using the ROC curve. The area