Valsartan Decreases Type I Collagen Synthesis in Patients With Hypertrophic Cardiomyopathy

Background Fibrosis, as well as myocyte hypertrophy, is the major determinant of prognosis in hypertrophic cardiomyopathy (HCM). Valsartan, an angiotensin II type 1 receptor blocker, may improve myocardial fibrosis in patients with HCM. Methods and Results Twenty-three patients with HCM were randomly divided into 2 groups : 11 patients had valsartan added to conventional treatment (V group) and 12 patients received the conventional therapy (C group). Plasma concentrations of brain natriuretic peptide (BNP), troponin T (TnT), aldosterone (ALDO), procollagen type I (PIP) and procollagen type III aminoterminal peptide (PIIINP) were measured before and 12 months after this study. Left ventricular wall thickness (LVWT) and ejection fraction (LVEF) were measured by echocardiography. PIP was decreased in the V group (123.2±63.1ng/ml to 102.8±37.6, p<0.05), but unchanged in C group (110±40.5ng/ml to 119.9±47.4, p=0.22). ALDO concentration was unchanged in the V group (88.5±26.2pg/ml to 91.2±26.8, p=0.27), and increased in C group (92.6±36.6ng/ml to 116.0±33.3, p<0.05). BNP, PIIINP, and TnT were unchanged by the treatment. There was no significant difference between the 2 groups in either LVWT or LVEF. Conclusion Valsartan suppresses the synthesis of type I collagen in patients with HCM and this was associated with suppression of the increase in ALDO.