Open Access Research article

Can losartan and blood pressure control peri arteriovenous fistula creation ameliorate the early associated left ventricular hypertrophic response a randomised placebo controlled trial

Dominica Zentner1*, Eugenie Pedagogos2, Anthony Yapanis1, Sofie Karapanagiotidis1, Alison Kinghorn1, Athanasia Alexiou1, Geoffrey Lee1, Matija Raspudic2 and Anuradha Aggarwal1

Author Affiliations

1 Dept of Cardiology, Royal Melbourne Hospital, Grattan St, Parkville, 3050, Australia

2 Dept of Nephrology, Royal Melbourne Hospital, Grattan St, Parkville, 3050, Australia

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BMC Research Notes 2012, 5:260  doi:10.1186/1756-0500-5-260

Published: 29 May 2012

Abstract

Background

Haemodialysis results in a left ventricular hypertrophic response. It is unclear whether tight blood pressure control or particular medications might attenuate this response. We sought to determine, in a pre-dialysis cohort on atenolol, whether Losartan might attenuate left ventricular hypertrophy post arteriovenous fistula creation in end stage kidney disease.

Materials and methods

Placebo controlled double blind randomisation of 26 patients to fixed dose atenolol plus fixed dose losartan or placebo occurred 1 day prior to fistula creation. Pre-randomisation echocardiography was repeated at 1 week and 1-month. Measurement was undertaken of blood pressure, heart rate, brain natriuretic peptide, serum creatinine and estimated glomerular filtration rate. The primary pre-specified endpoint was the change in left ventricular mass at 1 month. Non-parametric statistical comparison was performed within and between groups.

Results

There was no difference in left ventricular mass between our groups 1-month post fistula creation. In the entire cohort, change in left ventricular mass was driven by changes in blood pressure and volume loading. Blood pressure changes correlated with left ventricular mass changes seen shortly post arteriovenous fistula creation, suggesting blood pressure control during this time period may be an important part of the management of end stage kidney disease.

Conclusions

We did not see an advantage with the use of losartan with respect to diminution of the LVM response. However, our demonstrated change in LVM was relatively small compared to previous literature and suggests a possible role for beta blockade as a neurohormonal modulator around the time of arteriovenous fistula creation.

Trial registration

Clinical trials.gov (NCT00602004).

Keywords:
Arteriovenous fistula; Blood pressure; Echocardiography, Transthoracic; Hypertrophy, Left ventricular; Haemodialysis