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The Effects of Amlodipine on Left Ventricular Mass and Diastolic Function in Concentric and Eccentric Left
1Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
Insights
Amlodipine effectively lowers blood pressure and reduces left ventricular mass in hypertensive patients with concentric left ventricular hypertrophy (LVH). However, it does not improve diastolic dysfunction or affect eccentric LVH.
Area of Science:
- Cardiology
- Pharmacology
- Echocardiography
Background:
- Essential hypertension is often associated with left ventricular hypertrophy (LVH) and diastolic dysfunction.
- Amlodipine is a widely used antihypertensive medication.
- The impact of amlodipine on LVH regression and diastolic function requires further elucidation, particularly concerning different LVH types.
Purpose of the Study:
- To investigate the effects of amlodipine (5-10 mg/day) on left ventricular mass and diastolic function in patients with essential hypertension and LVH.
- To determine if amlodipine-induced regression of LVH differs between concentric and eccentric types.
- To assess the impact of amlodipine on diastolic function parameters.
Main Methods:
- A prospective study involving 30 patients with mild to moderate essential hypertension, LVH, and diastolic dysfunction.
- Echocardiographic Doppler assessment of left ventricular mass and diastolic function at baseline, 3 months, and 6 months.
- Patients were categorized based on left ventricular hypertrophy type (concentric vs. eccentric).
Main Results:
- Amlodipine significantly reduced blood pressure and left ventricular mass index at 3 and 6 months.
- Significant regression of left ventricular mass index was observed only in patients with concentric LVH (relative wall thickness ≥0.44).
- No significant changes in mitral inflow E/A ratio were noted, indicating no improvement in diastolic dysfunction.
Conclusions:
- Amlodipine effectively reduces left ventricular mass in hypertensive patients with concentric LVH.
- The type of LVH influences the response to antihypertensive therapy regarding mass regression.
- Amlodipine does not improve diastolic dysfunction in this patient population.
Abstract:
BACKGROUND: The effects of the antihypertensive therapy with amlodipine (5-10 mg/day) on left ventricular mass and diastolic function were examined in 30 mild to moderate essential hypertensive patients who have left ventricular hypertrophy (LVH) and diastolic dysfunction. METHODS AND RESULTS: Each patient's left ventricular mass was measured, and left ventricular diastolic function was assessed by echocardiographic Doppler examination at entry, and at 3 and 6 months after the initiation of the treatment. Amlodipine reduced both blood pressure (from 164 +/- 14/104 +/- 6 mmHg to 134 +/- 9/83 +/- 4 mmHg) and left ventricular mass index (from 160 +/- 30 g/m(2) to 137 +/- 26 g/m(2)) significantly at 3 months and both parameters maintained at these levels for 6 months. When the patients were classified according to the type of the LVH, a significant regression in left ventricular mass index was seen only in the patients who had concentric LVH was a relative wall thickness >/=0.44 (n = 16), but not in the eccentric LVH group (n = 14), although both groups were not significantly different from each other regarding the basal hemodynamic parameters, baseline left ventricular mass index and the decrease in blood pressure in response to amlodipine treatment. The mitral inflow E/A ratio did not show any significant change in either group. CONCLUSIONS: Amlodipine produced significant regression in LVH only in the patients with concentric LVH, but not those with eccentric LVH, while it did not change the diastolic dysfunction. Therefore, the type of LVH seems to be an important feature in determining the effects of antihypertensive treatment on left ventricular mass index.