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Fosinopril improves left ventricular diastolic function in young mildly hypertensive patients without hypertrophy
Nen-Chung Chang1, Chun-Ming Shih, Wei-Fung Bi
1Division of Cardiology, Department of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan.
Insights
Fosinopril monotherapy improved left ventricular diastolic function (LVDF) in young, mild hypertensives without hypertrophy. This treatment enhanced transmitral filling velocities and normalized pulmonary venous flow, unlike combination therapy.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Mild hypertension in young adults can present with impaired left ventricular diastolic function (LVDF) even without cardiac hypertrophy.
- Early detection and management of diastolic dysfunction are crucial for preventing cardiovascular complications.
Purpose of the Study:
- To investigate the efficacy of fosinopril monotherapy in improving LVDF in young, mild hypertensives with normal cardiac structure.
- To compare the effects of fosinopril with a combination therapy on diastolic function.
Main Methods:
- A study involving 66 young hypertensive patients (age <45) with diastolic blood pressure 90-100 mmHg and impaired LVDF.
- Patients received either fosinopril monotherapy (38 pts) or hydrochlorothiazide and hydralazine combination (28 pts) for 30 months.
- Doppler echocardiography was used to assess LVDF parameters before, during, and after treatment, with data compared to healthy controls.
Main Results:
- Fosinopril treatment significantly improved transmitral early (E) and atrial (A) filling velocities, and the E/A ratio (0.93 to 1.29, p < 0.01).
- Pulmonary venous flow patterns normalized in the fosinopril group; however, LV mass index and dimensions remained unchanged.
- The hydrochlorothiazide-hydralazine combination did not yield significant improvements in diastolic function.
Conclusions:
- Long-term fosinopril monotherapy effectively improves impaired LVDF in young, mild hypertensives without cardiac hypertrophy.
- Fosinopril offers a potential therapeutic strategy for diastolic dysfunction in this specific patient population.
- Diastolic function improvements were specific to fosinopril, highlighting its role beyond blood pressure reduction.
Abstract:
To clarify whether fosinopril monotherapy can improve left ventricular diastolic function (LVDF) in young mildly hypertensives without hypertrophy, we studied 66 patients (pts) with diastolic blood pressure 90-100 mmHg, aged <45 years, with normal 2-dimensional echocardiography (2-D echo), and impaired DF. Impaired DF was defined as a Doppler transmitral early (E) to atrial (A) filling velocity ratio (E/A ratio) <1. Thirty-eight pts were selected for fosinopril monotherapy. Mean age was 36 years. Duration of documented hypertension was 5.4 years. Mean daily dose of fosinopril was 20 mg. Twenty-eight controls were treated with hydrochlorothiazide and hydralazine combination. Sixty-six age- and sex-matched healthy subjects served to establish normal reference values of 2-D and Doppler echo measurements. All hypertensives were treated for 30 months and re-examined 4 weeks after cessation of treatment. The fosinopril-treated group showed improvements in transmitral E (52 +/- 8 cm/s, vs. 61 +/- 9 cm/s, p < 0.01), A (56 +/- 9 cm/s, vs. 47 +/- 6 cm/s, p < 0.05), and E/A ratio (0.93 +/- 0.16, vs. 1.29 +/- 0.18, p < 0.01). Moreover, the early to atrial velocity-time integral ratio (1.31 +/- 0.10, vs. 2.24 +/- 0.10, p < 0.001) improved. The pulmonary venous flow pattern normalized after fosinopril therapy. LV mass index, relative wall thickness, LV dimension, left atrial dimension, fractional shortening, heart rate, and body mass index did not change. The hydrochlorothiazide-hydralazine combination-treated group did not show an improved diastolic function. It is concluded that long-term fosinopril monotherapy leads to an improvement of impaired LVDF in young mildly hypertensives without hypertrophy.