bromocriptine and left ventricular hypertrophy
Bromocriptine induces regression of left ventricular hypertrophy in peritoneal dialysis patients.Mejia-Rodriguez O, Alvarez-Aguilar C, Vega-Gomez HE, Belio-Caro F, Vargas-Espinosa JM, Paniagua-Sierra JR.
Coordinacion de Educacion e Investigacion en Salud, Unidad de Medicina Familiar Number 80, Instituto Mexicano del Seguro Social, Morelia, Mich. email@example.com
Left ventricular hypertrophy (LVH) prevalence is very high in end stage renal disease (ESRD). It's a predictor of cardiac death in peritoneal dialysis patients. Noradrenalin, Angiotensin II and aldosterone are involved incardiac hypertrophy. Dopamine, acting at DA2 receptors inhibits norephinephrin release, antagonizes aldosterone and down-regulates AT1 receptor numbers, suggesting that DA2 agonists, like bromocriptine (BEC) could regress LVH. The objective of this study was to evaluate the changes in left ventricular mass in patients with ESRD in continuous ambulatory peritoneal dialysis (CAPD), by adding BEC to the treatment. An open clinical trial was conducted. Twenty patients were enrolled. Five formed the control group. Fifteen patients in the experimental group received BEC 2.5 mg three times daily over three months. M mode echocardiography and prolactin plasma levels were measured at the beginning and at the end of the study. The statistical analysis was performed using Student t test. The echocardiography reports showed a 24.4% decreased in left ventricular mass index (LVMI); the interventricular septum decreased 11.3%, the ejection fraction was not modified. The control group showed no difference. BEC-mediated decreases in left-ventricular mass in LVH patients on dialysis suggest that Dopaminergic agonists could be useful in caring for patients with ESRD and LVH.
J Cardiovasc Pharmacol. 2004 Mar;43(3):380-6.
Angiotensin receptor antagonist regresses left ventricular hypertrophy associated with diabetic nephropathy in dialysis patients.
Kanno Y, Kaneko K, Kaneko M, Kotaki S, Mimura T, Takane H, Suzuki H.
Department of Nephrology, Saitama Medical School, Saitama, Japan.
BACKGROUND: Left ventricular hypertrophy (LVH) is frequently found at the initiation of dialysis therapy for diabetic and hypertensive patients, and is highly predictive of future cardiac morbidity and mortality. Angiotensin type 1 receptor (AT1) antagonists may be able to regress LVH by mechanisms independent of their antihypertensive effects in diabetic patients. It is not known whether AT1 antagonists are able to reverse LVH in diabetic patients on dialysis therapy. METHOD: Twenty-four type II diabetic patients with end-stage renal disease who had just entered into hemodialysis therapy, and were diagnosed as having LVH evaluated by echocardiography, were selected from 3 dialysis units staffed by the faculty of Saitama Medical School between 1998 and 2001. The study was carried out for 1 year. All patients were randomly assigned to 2 groups. One group received an AT 1 antagonist, losartan 100 mg daily 30 minutes after the cessation of dialysis therapy on dialysis days, or in the evening when dialysis therapy did not occur. The control group received placebo. LVH was evaluated by echocardiography before the start of administration of drugs, at 4 and 8 months, and again at 12 months after the start of drug therapy. A systolic blood pressure of less than 140 mm Hg was the target blood pressure in both groups. RESULTS: Using repeated measures analysis of variance, applied to those with 4 echocardiograms, there were progressive decreases over time in the left ventricular mass index (LVMi), posterior wall thickness, and intraventricular wall thickness in patients receiving losartan. The biggest changes in mass and the other parameters occurred between baseline and at month 6. Compared with these changes in the patients receiving losartan, left ventricular internal diameters and their derived parameters (e.g., ejection fraction) remained unchanged throughout the study. In spite of a similar reduction of bp in the patients receiving placebo, no significant changes in echocardiographic parameters were found in these patients. CONCLUSION: An AT 1 antagonist, losartan, is beneficial for the regression of LVH in diabetic patients who started dialysis therapy under adequate blood pressure control.