Gremmler B1, Kisters K¹, Funke C¹, Ulbricht L2
1 Anna -Hospital, Internal Medicin-Nephrology-Hypertension-Centre, Herne, Germany
2 Marienhospital, Cardiology, Bottrop, Germany
 

The diastolic relaxation disorder is a sign of leftventricular dysfunction induced by a long-term hypertension and/or
coronary ischemia. It is observed as well despite effective treatment with antihypertensive drugs. The analysis of the
diastolic relaxation disorder is possible by using Doppler ultrasonography without interference of the patient, who can
report subjectively about dyspnea and angina equivalent. An influence on the diastolic relaxation disorder may be induced
by the drug ranolazine. Ranolazine inhibits the ischemic generated late sodiuminflux (I Na-late) and reduces
consequently the ischemic induced intracellular Na- and Ca-overload. On this mechanism the Ca effected diast. left-ventricular
wallaclampsia will be decreased. The agency of ranolazine is similar to the Ca-Antagonists; however without
influence concerning blood pressure and heart rate. The influence of ranolazine concerning the Mg-behavior was not
described. Study: We report about 12 hypertension-patients (73,5±10,9 y) with exclusion of a macrocoronary induced
ischemia under rest or exercise condition, who complained dyspnea and/or angina equivalents under exercise. Despite
continuation of the antihypertensive drugs these pat. showed a diastolic relaxation disorder (ab-normal E'A'-index) in the
Doppler-and tissuedopplerultrasonography. A coincidental exercise induced hypertension was excluded using a 24 h blood
pressure monitoring. After edu. advertising ranolazine (Ranexa®375mg, 2xd.) was administered additionally. During the
total observation the blood-pressure and the heart rate showed no alteration. The pat. reported a subjective amelioration.
After 9,5±2,2 days a decrease of the diastolic relaxation disorder was found in the control of tissue-dop-plerultrasonicmeasure.
A normalization of the E'A'-index (as parameter of diast. relaxation disorder) was observed in all 12 patients
(stat. sign. in 10 pat; p=0,01-0,0003). Furthermore no influence concerning the Mg-behavior was registered under the
additional ranolazine-application. Conclusion: The addition of antihypertensive drugtherapy with ranolazine showed a
subjective benefit concerning the reported dyspnea/angina equivalents in line with the diastolic relaxation disorder. There
was no influence concerning blood pressure and heart rate behavior. Objectively a relevant amelioration of the
tissuedopplerultrasonic parameters was observed .In case of a certification by a greater collective an application in the
treatment of hypertensive heartsyndrome with symptomatic leftventricular dysfunction may be possible. Furthermore no
influence concerning the magnesiumbehavior was registered under the additional ranolazine-application.