Trimetazidine MR in very elderly hypertensive patients with diastolic heart failure

Abstract

Purpose: To explore the efficiency of trimetazidine MR (T) in the treatment of chronic heart failure (CHF) with preserved ejection fraction (EF) in very elderly hypertensive. Material(s) and Method(s): 115 hypertensive pts aged 81,9+/-0,5 with CHF NYHA II were exemined by transthoracic Doppler echocardiography, duplex scanning of carotis and aorta, creatinine clearance (CC) calculated after Cocroft-Gault before and after 9-month treatment in two modes: enalapril and metoprolol (EM) and enalapril, metoprolol plus T (EMT). Results and discussion: Both EM and EMT treatment resulted in positive dynamics of clinical symptoms, blood pressure decrease. LVH regression, statistically more pronounced in EMT compared EM, was accompanied by improvement of left ventricular function. EF increased from 54,4+/-0,4% by 8.1% in EM and from 56.5+/-0.5 by 12.2% in EMT E/A - from 0.74+/-0.01 by 12% and from 0.74+/-0.01 by 16%, respectively (all p<0,05). Positive effect of T as a part of combined therapy was confirm by greater positive dynamics of LVH, EF, E/A, IVRT/RR (p<0.05 between EM and EMT). Better dynamics of clinical symptoms and quality of life improvement was also related to noncardiac influences of T. Regression of vascular hypertrophy assessed by carotid intima-media thickness (IMT) reducing did not differed in two groups: IMT decreased from 0.99+/-0.01 to 0.97+/-0.01cm in EM (p<0,05) and from 0.97+/-0.02 to 0.94+/-0.01 cm in EMT (p<0,05) with no statistically significant differences two treatment groups. The ultrasound study of local aorta elasticity demonstrated the more marked decrease of index of aorta rigidity (SI) EMT (by 20,2%, p<0.001) compared EM (by 16,8%, p<0.001) group with statistically significant differences between EM and EMT treatment. EM treatment led to acceleration of initially low CC in CHF 55.4+/-2.5 to 61.3+/-3.0 ml/min in EM and from 55,3+/-3,3 to 68,3+/-3,4 ml/min in adjuvant T prescribing (all p<0.05 with statistically significant differences between EM and EMT treatment). Conclusion(s): 9-month therapy with IACE and beta-blocker in very elderly hypertensive, complicated by CHF with preserved EF, along with blood pressure lowering effect resulted in regression of LVH with concomitant improvement both systolic and diastolic function, reduction of IMT with the increase of local aorta distensability, the rise of CC Metabolic effects of trimetazidine MR are essential for greater improvement of systolic and diastolic heart function, aorta elasticity as well as glomerular filtration.