D003: Candesartan regresses left ventricular hypertrophy and improves ejection fraction in hypertensive diabetic patients

Since left ventricular hypertrophy (LVH) is an independent risk factor for hypertensive diabetics, bp therapy for DM must regress LVH and lower bp. Candesartan (C) is a long acting angiotensin II receptor inhibitor (ARB). ARB had been proposed as an antihypertensive of choice for DM due to its comparable effectiveness albeit lesser side effect than ACE inhibitor. Losartan has been shown to regress LVH but there is no study on the effect of C on LVH in diabetics. We studied the effect of C on LVH and ejection fraction (EF) in hypertensive diabetic patients. Six hypertensive diabetic men, aged 58–69 y, with echocardiographic proven LVH were treated with C 8–16 mg/d. Echocardiograms were done q 2 mo. Regression of LVH was noted by 4 mo, and improvement of EF by 6 mo. LV dimensions were normal in 10 mo. (See Table) Post wall (mm) Septum (mm) LV mass index (g/m2) EF (%) Basal 12.6 ± 1.3 12.5 ± 1.2 155 ± 21 40 ± 16 2 mo 12.1 ± 1.0 12.0 ± 1.0 151 ± 18 42 ± 18 4 mo 11.0 ± 1.1 10.8 ± 0.8 143 ± 17 45 ± 14 6 mo 10.4 ± 0.9 10.2 ± 1.1 131 ± 14 48 ± 10 8 mo 10.0 ± 0.8 9.9 ± 0.7 121 ± 11 50 ± 11 10 mo 9.9 ± 0.8 9.8 ± 0.6 119 ± 10 54 ± 12 Thus, candesartan regresses LVH and improves EF in hypertensive diabetic patients. These cardioprotective properties with paucity of side effect make candesartan an ideal alternative for hypertensive diabetics with LVH who cannot tolerate ACE inhibitors.