Analysis of variance of repeated measures was used to compare the initial control, placebo and losartan values. ☆ This work was supported in part by research grants from the NIH (AG12257) and from Merck Research Laboratories. We may earn commission if you buy from a link. 1997;29(2A):205. No patient experienced angina. Neither losartan nor placebo had any significant effect on LV end-diastolic volume, IVRT, mitral E/A ratio, or E-wave deceleration (Table 4). Gear-obsessed editors choose every product we review. Runner's World participates in various affiliate marketing programs, which means we may get paid commissions on editorially chosen products purchased through our links to retailer sites. In: Heart Disease . Aldigier J.C, Huang H, Dalmay Fet al. Little W.C and Braunwald E: Assessment of cardiac function. 14. Furthermore, Ang II impairs LV relaxation (10). Effect of Losartan on Echo-Doppler Measures of Diastolic Performancelegend. Systolic arterial pressure normally increases during exercise. On the basis of isolated anecdotal experience, it has been suggested that ACE inhibitors should be avoided in elderly patients with diastolic dysfunction because of hypertensive LV hypertrophy (23). A randomized, double-blind study of 6 months of losartan 50 mg or hydrochlorothiazide (HCTZ) 12.5 mg was performed in 40 subjects with left ventricular diastolic dysfunction (mitral flow velocity E/A ratio <1), exercise … Data are expressed as mean ± SD. In the RENAAL study -- a premarketing study -- 14 percent of the 1,513 participants reported feelings of fatigue. The peak SBP during exercise was 226 ± 24 mm Hg and was greater than 200 mm Hg in all patients (an entry criteria). Thus, a change in the baseline diastolic function is not the mechanism of losartan’s action. After two weeks of losartan, baseline BP was unaltered, but … These improvements occurred despite relatively good exercise tolerance (11.3 ± 2.5 min), mild symptoms and normal SBP at baseline. The duration of exercise in our study may have been influenced by the patients’ motivation and subjective interpretation of their symptoms during exercise. : "Impact of age on the cardiovascular response to dynamic upright exercise in healthy men and women". Two weeks of losartan therapy did not alter any Doppler-echocardiographic measure of LV diastolic performance (mitral E/A, IVRT or deceleration time) at rest. : "Evaluation of left ventricular diastolic function from the pattern of left ventricular filling". Oh J.K, Appleton C.P, Hatle L.Ket al. i take 100mg losartan daily, i've lost weight, cut out caffeine and alcohol.and exercise regularly .my bp is consistant 125/77. All baseline medications were continued during the study. (21)found that five weeks of therapy with the calcium channel blocker verapamil improved treadmill exercise time in patients with symptomatic heart failure and normal LV ejection fractions. and exercise capacity 14,15 . However, peak SBP during exercise was reduced on losartan to 193 ± 27 mm Hg compared to placebo (217 ± 26, p < 0.05) and baseline (226 ± 24 mm Hg, p = NS). The phase IV clinical study is created by eHealthMe based on reports of 31,030 people who have side effects when taking Losartan potassium … 10. Quality of life assessed by the modified Minnesota Living With Heart Failure score improved to 18 ± 22 on losartan compared with placebo (22 ± 26, p < 0.05), which was similar to baseline (25 ± 22). Am J Cardiol 1990; 66: 981. No other subject developed any abnormality of serum electrolytes or creatinine. However, the effects of losartan and verapamil in these studies cannot be directly compared owing to the different selection criteria used. † p < 0.05 (Losartan vs. Baseline). Exercise, exercise and losartan, and losartan … All of our patients were asymptomatic at rest but had dyspnea with exertion. Although not all of these side effects may occur, … Because ACE inhibitors do not prevent the increase in circulating Ang II that occurs during exercise (9), it is possible that ACE inhibition may not produce the same beneficial effects seen with an Ang II receptor blocker in our study. The aim of the study was to test the hypothesis that angiotensin II (Ang II) blockade would improve exercise tolerance in patients with diastolic dysfunction and a marked increase in systolic blood pressure (SBP) during exercise. Resting BP was well controlled (143/79 ± 8/8 mm Hg) at baseline. This effect may be accentuated in the failing heart and also in hypertrophied myocardium (10–12). Abstract. Runner Honors Stacey Abrams With Strava Portrait, How to Use Heart Rate Training to Get Faster, Aliphine Tuliamuk Gives Birth to Her Daughter, This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. 9. It is used to lower the chance of … We gratefully acknowledge the technical assistance of Sandra Soots, RN, Kim Stallings, MS, Karen Fowle, RDMS, RT, Piper Millsaps, RDCS, Kathy Stewart, RDMS, RT, and secretarial support of Carol S. Corum, MA. Results Losartan and exercise plus losartan significantly decreased systolic blood pressure (SBP). Bonow R.O, Dilsizian V, Rosing D.Ret al. The transmitral flow velocity was measured using pulsed-wave Doppler with the sample volume positioned between the mitral leaflet tips during diastole (16). The mean age was 64 ± 10 years (range 53 to 79 years). Baseline Doppler Echocardiographic Characteristics. Side Effects. Twenty-one patients entered the study. The exercise-induced increase in systolic arterial pressure may be partially mediated by angiotensin II (Ang II), whose circulating levels increase during exercise (9). Thus, some of the beneficial effect of losartan in our study may have been due to blocking the effect of Ang II on LV relaxation during exercise. In 16 of the 20 patients, exercise time was longer on losartan than placebo, in two patients it was identical, and in two others exercise time was longer on placebo by one min. Losartan is an angiotension receptor blocker (ARB), inhibiting the effect of angiotensin II on a number of sites in the body. They also had no effect on resting SBP or heart rate. 18. Alternatively, the lower SBP during losartan exercise may have influenced the examiner to push the subject further. Edited by Braunwald E. Philadelphia: W.B. For many people, lifestyle changes, such as diet, … During control, patients were able to exercise for 11.3 ± 2.5 (mean ± SD) min, with a peak exercise SBP of 226 ± 24 mm Hg. : "Angiotensin-converting enzyme inhibition does not suppress plasma angiotensin II increase during exercise in humans". We studied patients with diastolic dysfunction manifested by an altered Doppler-echocardiographic pattern of LV filling with a reduced mitral valve E wave and enhanced A wave. Sixteen patients had a past history of hypertension but had resting SBP ≤150 mm Hg on medications at the time of entry into the study (Table 1). 13. Circulation 1994; 89: 1648. One patient experienced an increase in serum creatinine from 1.5 to 2.0 mg/dl while receiving the initial study medication (losartan). Now I'm on 50mg Losartan no side effects that I can tell. Drug information provided by: IBM Micromedex Along with its needed effects, a medicine may cause some unwanted effects. Serious Interactions. There were no substantial differences between losartan and captopril, and no changes occurred in neurohormones or exercise capacity. 21. Both systolic and diastolic BP readings at rest were not altered by losartan or placebo. 5. Your physician may recommend a stress test to evaluate blood pressure and pulmonary function while running. Consult your healthcare professional … ; Both losartan and valsartan are used to treat high blood pressure (hypertension). Your … Sixteen of the patients in our study were taking a variety of common antihypertensive medications, including beta-adrenergic blocking agents, ACE inhibitors, and calcium channel blockers. Losartan and valsartan are angiotensin receptor blockers that work by blocking angiotensin II that causes blood vessels to constrict.This causes blood vessels to dilate which helps reduce blood pressure and the workload on the heart. The addition of an angiotensin AT1-receptor blocker, losartan, to the patients’ medications improved our subjects’ ability to walk on a treadmill by approximately 1 min using the Modified Bruce Protocol. What is the mechanism of the losartan-induced improvement of exercise tolerance in our study? This is dramatically apparent in patients who develop flash pulmonary edema in association with a marked increase in systolic BP (SBP) (>200 mm Hg) (5). Satellite cell (SCl Pax7 +) number per fiber assessed on cross sections of muscle biopsies collected from elderly men, receiving losartan or placebo, on days −10 and −3 before one bout of heavy-resistance exercise and after exercise … When I didn't take losartan for a few days, the problem wasn't there any more, so it's not my heart making the trouble (cardiac echo and exercise test were also normal). --Juha. Baseline serum electrolytes, resting 2-D echocardiogram, and Doppler measurements of mitral valve flow velocities were obtained. Many elderly subjects and patients with hypertension or left ventricular (LV) hypertrophy have Doppler echocardiographic evidence of impaired diastolic function, but do not have any symptoms of heart failure at rest (1–3). Although the patients’ mean BP was 143/79 mm Hg at rest on their baseline medication and not reduced further at rest by the addition of losartan, it is possible that more aggressive antihypertensive therapy with agents other than an Ang II receptor blocker could have produced a similar improvement in exercise tolerance. Clin Pharmacol Ther 1995; 58: 641. The trend toward lower total mortality was in favor of losartan, and patients treated with losartan also had a 25 percent lower incidence of new-onset diabetes. Hypertension 1991; 17: 574. Doctors most commonly prescribe losartan potassium to treat hypertension in adults and children over 6 years of age. Immediately after exercise the Doppler-echocardiogram was repeated. Then the study medication was discontinued for two weeks, and the patients then crossed over to placebo or losartan. Table 2. The losartan may lower your blood pressure to a level that causes fatigue and shortness of breath at a lower level of exertion. 24. The exercise time was similar during baseline (11.3 ± 2.5 min) and placebo (11.0 ± 2.0) but significantly (p < 0.05) increased during losartan (12.3 ± 2.6 min). Diastolic dysfunction may be exacerbated during exercise, especially if there is a marked increase in SBP. Nishimura R.A and Tajik A.J: "Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta stone". J Am Coll Cardiol . Because the Minnesota Living With Heart Failure score is not normally distributed, the placebo and losartan scores were compared using the Wilcoxin signed rank-sum test (17). Conclusion: These results suggest that both exercise and losartan have renoprotective effects, and the combination of exercise and losartan provided greater renoprotective effects than losartan … ), Everything You Need to Know About Hip Injuries, These Pace Charts Will Guide Your Virtual Race. But angiotensin is synthetized in the lungs, and this is surely not coincidental, i.e., it must have a function there, too. : "Intracoronary angiotensin-converting enzyme inhibition improves diastolic function in patients with hypertensive left ventricular hypertrophy". … Thus, the benefit we observed with losartan occurred in addition to any beneficial effects of these other medications. J Am Soc Echocardiogr 1997; 10: 246. : "Recommendations for quantitation of the left ventricle by two-dimensional echocardiography". Ask the Coaches: Blood Pressure Medication, Ask the Coaches: Conflicting Coaching Advice. 17. 15. Despite well-controlled BP at rest, our patients had an increase in SBP to >200 mm Hg during exercise prior to treatment with losartan. Thus, it is likely that diastolic dysfunction may limit exercise tolerance before resulting in symptoms at rest. The resting mitral valve E/A ratio was 0.75 ± 0.13 and less than 1.0 in all subjects (an entry criteria). Accordingly, we performed a randomized, double-blind, placebo-controlled, crossover study of the Ang II receptor blocker, losartan, on exercise tolerance and quality of life in patients with Doppler-echocardiographic evidence of mildly impaired diastolic performance and a marked hypertensive response to exercise. Cardiology Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045, USA. Similarly, short-term verapamil therapy increased exercise tolerance in patients with diastolic dysfunction due to hypertrophic cardiomyopathy (22). Side effects. It is “an angiotensin receptor blocker” (also called an angiotensin-II receptor antagonist (AIIRA)). Losartan/hydrochlorothiazide is a prescription medication. We performed a randomized, double-blind, placebo-controlled, crossover study of two weeks of losartan (50 mg q.d.) Kitzman D.W, Sheikh K.H, Beere P.Aet al. However, a longer course of therapy might have produced improvement in diastolic function by inducing regression in patients with LV hypertrophy. In patients with Doppler evidence of diastolic dysfunction at rest and a hypertensive response to exercise, Ang II receptor blockade blunts the hypertensive response to exercise, increases exercise tolerance and improves quality of life. : "Cardiovascular responses to exercise: effects of aging and exercise training in healthy men". After two weeks of therapy, the studies were repeated. ... You can also lose water by sweating, so drink plenty of water during exercise or in hot weather. 23. Drug efficacy was evaluated by changes in maximal treadmill exercise … on exercise tolerance and quality of life. The subjects were 20 patients, mean age 64 ± 10 years with normal left ventricular systolic function (EF >50%), no ischemia on stress echocardiogram, mitral flow velocity E/A <1, normal resting SBP (<150 mm Hg), and a hypertensive response to exercise (SBP >200 mm Hg). I have a strong subjective feeling that losartan impairs the ventilatory function of my lungs when I am engaged in strenuos sports, e.g., running, i.e., I become short of breadth much more easily than before. The E wave and A wave peak velocities, the ratio of the E wave to A wave peak velocities (E/A ratio), E wave deceleration time, and the isovolumetric relaxation time (IVRT) were measured on three separate beats and then averaged. J Am Coll Cardiol 1991; 18: 1243. Thus, it is possible that the beneficial effects of losartan would not persist with a longer duration of therapy. Circulation 1985; 72: 853. Angiotensin II slows the rate of LV relaxation and increases LV diastolic pressures (10). J Am Soc Echocardiogr 1989; 2: 358. The patients exercised for 11 ± 2.5 min on the initial exercise test, stopping because of dyspnea or fatigue. You may be able to find more information about this and similar content at piano.io, Dealing With Those Annoying Family Questions, Why Slowing Down Can Help You Get Faster (Really! About losartan. Lowering the arterial pressure produces a rapid resolution of the pulmonary edema. New York: McGraw-Hill1987. 16. Such systolic hypertension during exercise is common (perhaps typical) in subjects over 60 and occurs in many patients with hypertension even when BP is well controlled at rest (6,8). Losartan is a medication, routinely used in management of high blood pressure. Our observations demonstrate that Ang II receptor blocker with losartan was well tolerated and improved exercise tolerance and quality of life in the patients in our study, many of whom were elderly, some with LV hypertrophy. The patient was withdrawn from the study. Angiotensinogen is produced in the liver; several chemicals convert this to angiotensin I and then angiotensin II. Treatment with losartan increased exercise time and reduced peak systolic BP during exercise compared to baseline and placebo. I would not advocate discontinuation of the losartan without the approval of your physician! : "Age-related alterations of Doppler left ventricular filling indexes in normal subjects are independent of left ventricular mass, heart rate, contractility, and loading conditions". 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