The effectiveness of differentiated therapy with renin-angiotensin-aldosterone blockers in patients with heart failure and type 2 diabetes mellitus
Journal Title: Український терапевтичний журнал - Year 2018, Vol 0, Issue 2
Abstract
Objective — to evaluate the efficacy of differentiated therapy for ACE inhibitors and ARB II in patients with HFpEF and type 2 diabetes mellitus (DM 2), depending on the M235T polymorphism of the ATG gene. Materials and methods. Examinations involved 83 patients with HFpEF and T2DM II—III class NYHA. To determine genotypes of ATG M235T gene, molecular-genetic testing of DNA by PCR was carried out. The level of NT-proBNP, ST2 in serum was determined by ELISA. Doppler cardiography was performed with ultrasonic method. Statistical data processing carried out using Statistica v.10.0. Results and discussion. After determining the genotype, the patients were divided into 4 groups: the 1 group included carriers of the T allele to which ramipril was assigned, group 2 received valsartan, patients of 3 and 4 group with the genotype MM, received ramipril, and valsartan, respectively. After 12 months of therapy, patients were re-examined. It has been established that in patients with the T allele who took valsartan, the blood pressure decrease was more significant than in the ramipril group (p < 0.05). The method of multifactorial regression analysis was used to obtain a model for assessing the development of adverse events in patients with HFpEF and type 2 DM. It was characterized by a higher significance degree (p < 0.0001) and accounted for more than 86 % of events (the coefficient of determination adjusted R2 = 0.867931). The prognostic factors of the risk of adverse events in patients with HFpEF and type 2 DM was LVMMI, a high level of NT-proBNP and ST2, the genotype of MT + TT, the intake of ACE inhibitors, the age, the experience of HF, and the higher score for the Minnesota questionnaire. Conclusions. In T allele carriers of polymorphism ATG M235T, who took valsartan, the blood pressure decreased significantly better than with the therapy with ramipril. The use of valsartan reduced the risk of developing adverse events during 12 months of follow-up in patients with chronic LVSCH and LV type 2 diabetes.
Authors and Affiliations
Yu. S. Rudyk, О. О. Medentseva, I. G. Kravchenko, Т. V. Lozyk
Keywords
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- EP ID EP420991
- DOI 10.30978/UTJ2018-2-74
- Views 88
- Downloads 0
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