Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial
Abstract Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricu...
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Nature Portfolio
2023-08-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-39779-y |
| _version_ | 1797752746442489856 |
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| author | Shin Ito Hiroyuki Takahama Masanori Asakura Yukio Abe Masayoshi Ajioka Toshihisa Anzai Takuo Arikawa Takaharu Hayashi Yorihiko Higashino Shinya Hiramitsu Noriaki Iwahashi Chisato Izumi Kazuo Kimura Koichiro Kinugawa Hidetaka Kioka Young-Jae Lim Ken Matsuoka Satoshi Matsuoka Hirohiko Motoki Sunao Nakamura Takafumi Nakayama Akihiro Nomura Taishi Sasaoka Shin Takiuchi Shigeru Toyoda Tomoya Ueda Tetsuya Watanabe Akira Yamada Masayoshi Yamamoto Takashi Sozu Masafumi Kitakaze |
| author_facet | Shin Ito Hiroyuki Takahama Masanori Asakura Yukio Abe Masayoshi Ajioka Toshihisa Anzai Takuo Arikawa Takaharu Hayashi Yorihiko Higashino Shinya Hiramitsu Noriaki Iwahashi Chisato Izumi Kazuo Kimura Koichiro Kinugawa Hidetaka Kioka Young-Jae Lim Ken Matsuoka Satoshi Matsuoka Hirohiko Motoki Sunao Nakamura Takafumi Nakayama Akihiro Nomura Taishi Sasaoka Shin Takiuchi Shigeru Toyoda Tomoya Ueda Tetsuya Watanabe Akira Yamada Masayoshi Yamamoto Takashi Sozu Masafumi Kitakaze |
| author_sort | Shin Ito |
| collection | DOAJ |
| description | Abstract Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricular (LV) diastolic function in patients with hypertension and either HFpEF or HF with mildly reduced ejection fraction (HFmrEF) more than candesartan. In this randomized, open-label trial, we randomly assigned 193 hypertensive patients with HF and LV ejection fraction ≥ 45% to 20 mg of azilsartan (n = 95) or 8 mg of candesartan (n = 98), once daily for 48 weeks. After the initiation of treatment, changes in the doses of the study drugs were permitted based on the patient’s conditions, including blood pressure (median dose at 48 weeks: azilsartan 20.0 mg/day, candesartan 8.0 mg/day). The primary endpoint was the baseline-adjusted change in the ratio of peak early diastolic transmitral flow velocity (E) to early diastolic mitral annular velocity (e′) (E/e′). Adjusted least-squares mean (LSM) change in E/e′ was − 0.8 (95% confidence interval [CI] − 1.49 to − 0.04) in the azilsartan group and 0.2 (95% CI − 0.49 to 0.94) in the candesartan group, providing the LSM differences of − 1.0 (95% CI − 2.01 to 0.03, P = 0.057). The median change in left atrial volume index was – 2.7 mL/m2 with azilsartan vs 1.4 mL/m2 with candesartan (P = 0.091). The frequency of adverse events related to hypotension and hyperkalemia did not differ between the groups. The current study did not provide strong evidence that azilsartan improves LV diastolic dysfunction, and further confirmatory study is required. |
| first_indexed | 2024-03-12T17:07:57Z |
| format | Article |
| id | doaj.art-2332815c35694fada98cbf50e45264af |
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| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-12T17:07:57Z |
| publishDate | 2023-08-01 |
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| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-2332815c35694fada98cbf50e45264af2023-08-06T11:14:11ZengNature PortfolioScientific Reports2045-23222023-08-0113111210.1038/s41598-023-39779-yEfficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trialShin Ito0Hiroyuki Takahama1Masanori Asakura2Yukio Abe3Masayoshi Ajioka4Toshihisa Anzai5Takuo Arikawa6Takaharu Hayashi7Yorihiko Higashino8Shinya Hiramitsu9Noriaki Iwahashi10Chisato Izumi11Kazuo Kimura12Koichiro Kinugawa13Hidetaka Kioka14Young-Jae Lim15Ken Matsuoka16Satoshi Matsuoka17Hirohiko Motoki18Sunao Nakamura19Takafumi Nakayama20Akihiro Nomura21Taishi Sasaoka22Shin Takiuchi23Shigeru Toyoda24Tomoya Ueda25Tetsuya Watanabe26Akira Yamada27Masayoshi Yamamoto28Takashi Sozu29Masafumi Kitakaze30Department of Cardiovascular Medicine, National Cerebral and Cardiovascular CenterDepartment of Cardiovascular Medicine, National Cerebral and Cardiovascular CenterDepartment of Clinical Medicine and Development, National Cerebral and Cardiovascular CenterDepartment of Cardiology, Osaka City General HospitalDepartment of Cardiovascular Internal Medicine, Tosei General HospitalDepartment of Cardiovascular Medicine, Hokkaido University Graduate School of MedicineDepartment of Cardiovascular Medicine, Dokkyo Medical UniversityCardiovascular Medicine, Osaka Police HospitalDepartment of Cardiology, Higashi Takarazuka Satoh HospitalCardiology, Hiramitsu Heart ClinicDivision of Cardiology, Yokohama City University Medical CenterDepartment of Cardiovascular Medicine, National Cerebral and Cardiovascular CenterDivision of Cardiology, Yokohama City University Medical CenterThe Second Department of Internal Medicine, University of ToyamaDepartment of Cardiovascular Medicine, Osaka University Graduate School of MedicineCardiovascular Center, Kawachi General HospitalDepartment of Internal Medicine, Yoshikawa HospitalDepartment of Cardiology, New Tokyo HospitalDepartment of Cardiovascular Medicine, Shinshu University School of MedicineDepartment of Cardiology, New Tokyo HospitalDepartment of Cardiology, Nagoya City University Graduate School of Medical SciencesInnovative Clinical Research Center/Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical SciencesInternal Medicine, Watanabe ClinicDepartment of Cardiology, Higashi Takarazuka Satoh HospitalDepartment of Cardiovascular Medicine, Dokkyo Medical UniversityDepartment of Cardiovascular Medicine, Nara Medical UniversityDivision of Cardiology, Osaka General Medical CenterDepartment of Cardiology, Fujita Health University School of MedicineDepartment of Cardiology, Faculty of Medicine, University of TsukubaDepartment of Information and Computer Technology, Faculty of Engineering, Tokyo University of ScienceDepartment of Clinical Medicine and Development, National Cerebral and Cardiovascular CenterAbstract Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricular (LV) diastolic function in patients with hypertension and either HFpEF or HF with mildly reduced ejection fraction (HFmrEF) more than candesartan. In this randomized, open-label trial, we randomly assigned 193 hypertensive patients with HF and LV ejection fraction ≥ 45% to 20 mg of azilsartan (n = 95) or 8 mg of candesartan (n = 98), once daily for 48 weeks. After the initiation of treatment, changes in the doses of the study drugs were permitted based on the patient’s conditions, including blood pressure (median dose at 48 weeks: azilsartan 20.0 mg/day, candesartan 8.0 mg/day). The primary endpoint was the baseline-adjusted change in the ratio of peak early diastolic transmitral flow velocity (E) to early diastolic mitral annular velocity (e′) (E/e′). Adjusted least-squares mean (LSM) change in E/e′ was − 0.8 (95% confidence interval [CI] − 1.49 to − 0.04) in the azilsartan group and 0.2 (95% CI − 0.49 to 0.94) in the candesartan group, providing the LSM differences of − 1.0 (95% CI − 2.01 to 0.03, P = 0.057). The median change in left atrial volume index was – 2.7 mL/m2 with azilsartan vs 1.4 mL/m2 with candesartan (P = 0.091). The frequency of adverse events related to hypotension and hyperkalemia did not differ between the groups. The current study did not provide strong evidence that azilsartan improves LV diastolic dysfunction, and further confirmatory study is required.https://doi.org/10.1038/s41598-023-39779-y |
| spellingShingle | Shin Ito Hiroyuki Takahama Masanori Asakura Yukio Abe Masayoshi Ajioka Toshihisa Anzai Takuo Arikawa Takaharu Hayashi Yorihiko Higashino Shinya Hiramitsu Noriaki Iwahashi Chisato Izumi Kazuo Kimura Koichiro Kinugawa Hidetaka Kioka Young-Jae Lim Ken Matsuoka Satoshi Matsuoka Hirohiko Motoki Sunao Nakamura Takafumi Nakayama Akihiro Nomura Taishi Sasaoka Shin Takiuchi Shigeru Toyoda Tomoya Ueda Tetsuya Watanabe Akira Yamada Masayoshi Yamamoto Takashi Sozu Masafumi Kitakaze Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial Scientific Reports |
| title | Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial |
| title_full | Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial |
| title_fullStr | Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial |
| title_full_unstemmed | Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial |
| title_short | Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial |
| title_sort | efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan j taste randomized controlled trial |
| url | https://doi.org/10.1038/s41598-023-39779-y |
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