This study was designed to assess the clinical efficacy of oral blood-activating and stasis-removing Chinese patent medicines in treating hypertensive left ventricular hypertrophy(LVH) based on network Meta-analysis. The clinical randomized controlled trials(RCTs) concerning the treatment of hypertensive LVH with oral blood-activating and stasis-removing Chinese patent medicines were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library from their inception to September 2021. Two researchers independently completed the literature screening, data extraction, and quality evaluation. The data were then analyzed by RevMan 5.3, Stata 15.1, and ADDIS 1.16.8. Finally, a total of 31 RCTs were included, involving 3 001 patients and four oral blood-activating and stasis-removing Chinese patent medicines. In terms of the alleviation of heart damage, the Chinese patent medicines combined with conventional western medicine groups were superior to the conventional western medicine groups in lo-wering the left ventricular mass index(LVMI). There was no significant difference in LVMI, left ventricular ejection fraction(LVEF), or the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity(E/A) between different Chinese patent medicines combined with conventional western medicine groups. Xinnao Shutong Capsules/Tablets combined with conventional western medicine had the best efficacy in reducing LVMI and elevating LVEF, while Xinkeshu Capsules/Tablets combined with conventional western medicine had the best effect in improving E/A. In the control of blood pressure, when all Chinese patent medicines except for Xinnao Shutong Capsules/Tablets were combined with conventional western medicine, the resulting systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower than those in the conventional western medicine group. Xinkeshu Capsules/Tablets combined with conventional western medicine produced the best effect in reducing SBP and DBP, followed by Xinnao Shutong Capsules/Tablets. In terms of safety, no serious adverse reactions occurred in all trials. The four oral blood-activating and stasis-removing Chinese patent medicines included in this study exhibited obvious advantages in the treatment of hypertensive LVH when they were combined with conventional western medicine, with the best effects observed in the Xinnao Shutong Capsules/Tablets combined with conventional western medicine group. However, due to the limitation of the quantity and quality of the included articles, the conclusion of this study still needs to be verified by more high-quality, multi-center, and large-sample RCTs.
China ; Humans ; Hypertrophy, Left Ventricular/drug therapy* ; Medicine, Chinese Traditional ; Network Meta-Analysis ; Nonprescription Drugs ; Stroke Volume ; Ventricular Function, Left

To systematically evaluate the clinical efficacy and safety of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in the treatment of hypertensive left ventricular hypertrophy. China National Knowledge Infrastructure(CNKI), Wanfang, VIP, PubMed, EMbase, Cochrane Library, Ovid and Web of Science databases were searched by computer to retrieve the randomized controlled trials(RCTs) of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in the treatment of hypertensive left ventricular hypertrophy from the establishment of databases to July 2020. After two researchers performed data retrieval, data extraction, and risk assessment of bias, they used RevMan 5.3 software for Meta-analysis. A total of 10 RCTs were included, with a total of 979 patients. Meta-analysis results showed that in terms of interventricular septal thickness(MD=-0.70, 95%CI[-1.15,-0.24], P=0.003), left ventricular posterior wall thickness(MD=-0.81, 95%CI[-1.41,-0.21], P=0.008), left ventricular mass index(MD=-8.75, 95%CI[-17.40,-0.10], P=0.05), systolic blood pressure(MD=-8.97, 95%CI[-13.46,-4.48], P<0.000 1), diastolic blood pressure(MD=-5.87, 95%CI[-8.39,-3.34], P<0.000 01) and left ventricular end-diastolic diameter(MD=-1.73, 95%CI[-2.38,-1.08], P<0.000 01), Compound Danshen Dripping Pills combined with conventional antihypertensive drugs was superior to conventional antihypertensive drugs. In terms of left ventricular ejection fraction(MD=0.41, 95%CI[-0.74, 1.55], P=0.49), there was no statistical difference in treatment between the two groups. Because of the small amount of literatures included in the safety aspect, it is impossible to give an accurate conclusion. The GRADE score showed that the level of evidence was low and extremely low. The results show that the Compound Danshen Dripping Pills combined with conventional antihypertensive drugs may effectively improve the clinical efficacy for hypertensive ventricular hypertrophy, and the safety needs to be further explored. Due to the low quality of the included literatures, more high-quality RCTs are needed for verification.
Antihypertensive Agents/adverse effects* ; China ; Drugs, Chinese Herbal/adverse effects* ; Humans ; Hypertrophy, Left Ventricular/drug therapy* ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left

BACKGROUND: Left ventriculuar hypertrophy(LVH) detected by echocadiography has long been recognized as a consequence of hypertension as well as independent predictor of subsequent cardiovascular morbidity and mortality. Numerous studies have shown left ventricular hypertrophy regression in response to antihypertensive drug therapy. The advent of echocardiography has made possible the noninvasive estimation of left ventricular mass. In this study, we analyesd hypertensive patients with LVH and without LVH by echocardiography to assees the changes of the left ventricular mass(LVM) and diastolic function after one year antihypertensive therapy. METHODS: Twenty patients with established hypertension were studied. No patients had a previos history of antihypertensive therapy. Patients were divided two group ; patients with LVH(Group I), patients without LVH(Group II). We obtained the basal echocardiography at the diagnosis and follow-up echocardiography after 6months and 12months antihypertensive therapy with angiotensin converting enzyme inhibitor. RESULTS: 1) Group I ; Baseline blood pressure was 155/104mmHg and fell to 129/86mmHg (p < 0.05) after 12 months antihypertensive therapy. There was no significant reduction in heart rate. Group II ; Baseline blood pressure was 149/102mmHg and fell to 123/83mmHg (p < 0.05) after 12 months antihypertensive therapy. There was no significant reduction in heart rate. 2) Group I ; LVM was reduced significantly from 160g/m2 to 132g/m2 after 12 months antihypertensive therapy. Group II ; LVM was not significantly reduced after 12 months antihypertensive therapy. 3) Group I ; Time velocity intergral dimension E(Ei) was increased from 9.1cm to 12.5cm significantly(p < 0.05), and Ei/Ai was significantly increased from 1.7 to 2.1 (p < 0.05) after 12 months antihypertensive therapy. Group II ; There were no significantly interval changes in time velocity intergral dimension E(Ei), time velocity intergral dimension A (Ai) and Ei/Ai after 12 months antihypertensive therapy. CONCLUSIONS: We concluded that antihypertensive therapy with ACE inhibitor reduced significantly the lefe ventricular mass and increased left ventricular diastolic function in hypertensive patients with LVH. We demonstrate the useful role that echocardiographic evaluation of left ventricular structure and function may play in hypertension research.
Blood Pressure ; Diagnosis ; Drug Therapy ; Echocardiography ; Follow-Up Studies ; Heart Rate ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Mortality ; Peptidyl-Dipeptidase A

OBJECTIVETo observe the effects of phlegm-dispelling and blood stasis-resolving traditional Chinese drugs on the cell cycle of cardiac myocytes and left ventricular reconstruction in hypertensive rats.

METHODSBilateral renal artery stenosis was conducted to induce hypertension in rats, which were randomly divided into hypertensive model group (n = 10), sham-operated group (n = 8), high-dose drug group (n = 11) and low-dose drug group (n = 11), with 8 normal untreated rats as the normal control group. The systolic blood pressure (SBP) was measured in the tail artery of the rats. Two months after the operation, the left ventricular mass (LVM) and LVM index (LVI) were calculated in all the rats. The cell cycle changes in the left ventricular cardiac myocytes were evaluated using flow cytometry.

RESULTSThe mean blood pressure and LVI of the hypertensive model group were significantly higher than those of the normal control (P < 0.05) and sham-operated group (P < 0.01). After treatment with preparation of the traditional Chinese drugs at either high or low dose, the mean blood pressure and LVM of the rats showed obvious reduction, and LVI was decreased significantly compared with that of the model group (P < 0.05). Compared with the hypertensive model group which showed obviously decreased cell percentage in G0/G1 phase and increased S phase cells, the treatment at both doses significantly increased the cells in G0/G1 phase (P < 0.05) and decreased the S-phase cells (P < 0.05) to levels comparable to those in the normal control and sham-operated groups (P > 0.05). The percentage of G2/M-phase cells showed no significant difference between the groups (P > 0.05).

CONCLUSIONThe traditional Chinese drugs can significantly decrease blood pressure and LVI in hypertensive rats, and induce cell cycle arrest in G0/G1 phase to reverse left ventricular hypertrophy by regulating the cell cycle and inhibiting the division and proliferation of the cardiac myocytes.

Animals ; Cell Cycle ; drug effects ; Cells, Cultured ; Drugs, Chinese Herbal ; therapeutic use ; Hypertension ; complications ; drug therapy ; Hypertrophy, Left Ventricular ; drug therapy ; etiology ; pathology ; Male ; Myocytes, Cardiac ; pathology ; Phytotherapy ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Ventricular Remodeling ; drug effects

OBJECTIVETo explore whether the Astragalus injection (AI) has effect for reversing left ventricular hypertrophy and myocardial fibrosis induced by renal vascular hypertension in rats.

METHODSThirty male SD rats were randomized equally into three groups: the AI group, the control group and the sham-operated group. All rats, except those in the sham-operated group, were established into the hypertension models by two kidney one clip (2K1C) operation. Blood pressure was measured before operation and every 4 weeks after operation. AI intervention was given to rats in the AI group starting from the 4th week of experiment at dose of 8 g/kg by peritoneal injecting once a day for 8 weeks, while for rats in the other 2 groups, equal volume of normal saline was given instead. All rats were sacrificed 12 weeks after operation by cervical breaking. And indexes including left ventricular mass index (LVMI), left ventricular wall thickness (LVWT), inter-ventricular septal thickness (IVST), left ventricular diameter (LVD), cardiomyocytes diameter (CCD), collagen volume fraction (CVF), and peri-vascular volume collagen area (PVCA) in rats were measured.

RESULTSBlood pressure was not different in the three groups before operation (P>0.05), whereas it rose in the control group and the AI group 4, 8 and 12 weeks after operation correspondingly, showing no difference between the two groups, but significantly higher than that in the sham-operated group (P<0.05). The related indexes in the sham-operated group, control group and AI group were: LVMI, 2.71 +/- 0.24, 3.42 +/- 0.26, 3.13 +/- 0.23, respectively; LVWT (mm), 2.25 +/- 0.42, 4.26 +/- 0.48, 3.28 +/- 0.36; IVST (mm), 2.13 +/- 0.38, 3.98 +/- 0.32, 3.02 +/- 0.28; and LVD (mm), 3.76 +/- 0.29, 2.18 +/- 0.27, 2.82 +/- 0.20 respectively. Comparisons showed that LVMI, LVWT and IVST were significantly higher, but LVD was significantly lower in the control group than those in the sham-operated group (P<0.05); LVMI, LVWT and IVST were significantly lower but LVD was significantly higher in the AI group than those in the control group (P<0.05). CCD, CVF and PVCA in the three groups (in the fore-mentioned order) were: CCD (microm), 14.54 +/- 2.25, 19.56 +/- 2.53, 16.58 +/- 2.46; CVF(%), 3.83 +/- 1.40, 11.21 +/- 2.96, 7.83 +/- 1.67; PVCA (%), 15.71 +/- 3.85, 30.58 +/- 6.25, 21.76 +/- 4.36, respectively. These indexes showed that CCD, CVF, PVCA in the control group were significantly higher than those in the sham-operated group (P<0.05); and those were significantly lower in the AI group than in the control group (P<0.05).

CONCLUSIONAI intervention can reverse the left ventricular hypertrophy and myocardial fibrosis induced by renal vascular hypertension in rats.

Animals ; Astragalus Plant ; Blood Pressure ; Drugs, Chinese Herbal ; therapeutic use ; Hypertension, Renal ; drug therapy ; Hypertrophy, Left Ventricular ; prevention & control ; Injections ; Male ; Phytotherapy ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the different effects of an angiotensin II type 1 (AT(1)) receptor antagonist, losartan, and an angiotensin converting enzyme (ACE) inhibitor, fosinopril, on cardiomyocyte apoptosis, myocardial fibrosis, and angiotensin II (Ang II) in the left ventricle of spontaneously hypertensive rats (SHRs).

METHODSSHRs of 16-week-old were randomly divided into 3 groups: SHR-L (treated with losartan, 30 mg.kg(-1) x d(-1)), SHR-F (treated with fosinopril, 10 mg x kg(-1) x d(-1)), and SHR-C (treated with placebo). Each group consisted of 10 rats. Five rats, randomly selected from each group, were killed at the 8th and 16th week after treatment. Cardiomyocyte apoptosis, collagen volume fraction (CVF), perivascular collagen area (PVCA) and Ang II concentrations of plasma and myocardium were examined.

RESULTSCompared with the controls at the 8th and 16th week, systolic blood pressures were similarly decreased in both treatment groups. Left ventricular weight and left ventricular mass indexes were significantly lower in both treatment groups. However, the latter parameter at the 16th week was reduced to a less extent in the fosinopril group than that in the losartan group. Compared with the controls, cardiomycyte apoptotic index was significantly reduced at the 8th week only in the fosinopril group, and at the 16th week in both treatment groups. The index of the fosinopril group was lower than that of the losartan group at the latter endpoint examined. Compared with the controls, the left ventricular collagen volume fraction and perivascular collagen area at the 8th and 16th weeks were significantly reduced in the SHRs treated with either fosinopril or losartan. However, the collagen volume fraction at the latter endpoint in the fosinopril group was lower than that in the losartan group. Compared with the controls at endpoints, plasma and myocardium Ang II levels were significantly increased in the losartan group. However, plasma Ang II concentrations were not altered, and myocardium Ang II concentrations at the 8th and 16th weeks were significantly reduced in the fosinopril group.

CONCLUSIONSBoth losartan and fosinopril could effectively inhibit cardiomyocyte apoptosis and myocardial fibrosis and reverse heart hypertrophy. Fosinopril may be more effective in these cardioprotective effects, suggesting that the effects of both drugs are related to the inhibition of myocardium renin-angiotension-aldsterone system.

Angiotensin II ; analysis ; Animals ; Antihypertensive Agents ; therapeutic use ; Apoptosis ; drug effects ; Blood Pressure ; drug effects ; Fibrosis ; Fosinopril ; therapeutic use ; Hypertension ; complications ; drug therapy ; Hypertrophy, Left Ventricular ; drug therapy ; Losartan ; therapeutic use ; Myocardium ; chemistry ; pathology ; Rats ; Rats, Inbred SHR

OBJECTIVETo investigate the effects of losartan on left ventricular hypertrophy (LVH) and plasma transforming growth factor-beta1 (TGF-beta1) in elderly patients with essential hypertension (EH).

METHODSThe elderly patients with EH were divided into two groups, namely EH+LVH group and EH group according to the data of echocardiogram. The systolic and diastolic blood pressures of the patients were monitored. Plasma TGF-beta1 was measured before and after 6 months' treatment with losartan, and the relationship between TGF-beta1 and other index were analyzed.

RESULTSAfter 6 months' treatment, the blood pressure of EH+LVH group and EH group were significantly lowered (P<0.01). Significant improvement of IVSTd, LVPWd, E/A, and LVMI (P<0.01) and obvious reduction of plasma TGF-beta1 (P<0.01) occurred in EH+LVH group after 6 months' treatment. Correlation analyses indicated that the plasma TGF-beta1 level was positively correlated to LVMI (P<0.01).

CONCLUSIONLosartan can reversed LVH in elderly patients with EH partially by lowering plasma TGF-beta1 level.

Aged ; Antihypertensive Agents ; therapeutic use ; Female ; Humans ; Hypertension ; blood ; complications ; drug therapy ; Hypertrophy, Left Ventricular ; blood ; drug therapy ; etiology ; Losartan ; therapeutic use ; Male ; Middle Aged ; Transforming Growth Factor beta1 ; blood

The transmural heterogeneous changes of transient outward potassium currents (Ito) in rabbit hypertrophic cardiaomyocytes and the effects of long-term prophylactic treatment with volsartan were investigated. Rabbits were divided into hypertrophy group (left ventricular hypertrophy induced by partial ligation of abdominal aorta), vol-treated group (volsartan was administrated after the ligation), and control group (sham operated). Myocytes were isolated by a two-step enzymatical method. The sub-endocardial (Endo) and sub-epicardium (Epi) tissues were separated from midmyocardium (Mid) with a razor. Whole-cell patch-clamp technique was used to record potassium currents. The results showed that membrane capacitance was larger in hypertrophic cells than those in control and vol-treated cells (P<0.01 vs control cells, n=30). The densities of Ito in hypertrophic cells were reduced by sub-epicardium (Epi) (27.8 +/- 2.9) %, midmyocardium (Mid) (41.0+/-4.7) %, and sub-endocardium (Endo) (20.3 +/- 3.4) % compared with those in control cells. The decrease of Ito density was more pronounced in Mid than in Epi and Endo (P<0.01 vs Epi or Endo). There were no significant differences in Ito densities between vol-treated group and control group in three layers separately. In conclusion, volsartan can inhibit the transmural heterogeneous changes of Ito in left ventricular hypertrophic cardiomyocytes in rabbit.
Animals ; Antihypertensive Agents ; pharmacology ; Biological Transport, Active ; drug effects ; Female ; Hypertrophy, Left Ventricular ; drug therapy ; pathology ; Male ; Myocytes, Cardiac ; pathology ; Patch-Clamp Techniques ; Potassium Channels ; drug effects ; Rabbits ; Tetrazoles ; pharmacology ; Valine ; analogs & derivatives ; pharmacology ; Valsartan

OBJECTIVETo study the effect of Jiangya Tongmai Recipe (JYTMR), a Chinese herbal medicine preparation for activating blood circulation to remove stasis, on vascular activating substances in treating patients of hypertension with left ventricular hypertrophy.

METHODSThe 37 patients with hypertension were randomly divided into two groups, the treated group (n = 21) and the control group (n = 16). They were treated with JYTMR and captopril respectively for 8 weeks. Left ventricular mass weight (LVMI), peak flow velocity of early diastole (Emax), peak flow velocity of atrial contraction (Amax), Emax/Amax, ejection fraction (EF), as well as levels of plasma endothelin (ET), calcitonin gene-related peptide (CGRP) and angiotensin II (Ang II) were measured before and after treatment and compared.

RESULTSJYTMR could enhance the left ventricular dilation and contractile functions, lower the levels of plasma ET and Ang II and increase the level of plasma CGRP.

CONCLUSIONJYTMR shows good effect in improving left ventricular function and regulating vascular activating substances, it could prevent and treat hypertension and its complications for prolonged treatment via multiple paths and links.

Adult ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Calcitonin Gene-Related Peptide ; blood ; Captopril ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Endothelins ; blood ; Female ; Humans ; Hypertension ; blood ; drug therapy ; physiopathology ; Hypertrophy, Left Ventricular ; blood ; drug therapy ; physiopathology ; Male ; Middle Aged ; Phytotherapy ; Ventricular Function, Left ; drug effects

We aimed to study the effect of allitridum (All) on the transient outward potassium current (Ito) of ventricular myocytes of spontaneously hypertensive rats (SHR). Totally 30 male SHRs were randomly divided into three groups: low-dose All group (7.5 mg·kg(-1)), high-dose All group (15.0 mg·kg(-1)) and normal saline group. The other 10 sex and age matched Wistar-kyoto rats (WKY) were also taken as control group (WKY group). All animals received i.p. administration for 8 weeks. The dual enzymatic method was used to separate single ventricular myocyte from animals. Patch-clamp technique was used to record Ito and analyze the effect of All on the current. It was shown that the left ventricular hypertrophy of SHR was reversed significantly by All. Furthermore, the density of Ito was recovered in both high and low dose All groups. The peak current densities of Ito were enhanced from 18.23±3.64 to 25.17±2.86 pA/pF (P<0.01) and 36.47±5.42 pA/pF (P<0.01) at +50 mV by All 7.5 mg·kg(-1) and 15.0 mg·kg(-1), respectively, which was not significantly different with WKY group. The effect was associated with positive shift of the steady-state, close-state inactivation, and shortened recovery from inactivation of Ito. It is concluded that All decreases the remodeling of Ito of ventricular hypertrophic myocytes of SHR.
Allyl Compounds ; pharmacology ; Animals ; Hypertrophy, Left Ventricular ; drug therapy ; Male ; Myocytes, Cardiac ; cytology ; drug effects ; Patch-Clamp Techniques ; Potassium Channels ; metabolism ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Sulfides ; pharmacology