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Left ventricular mass regression in elderly hypertensives
1Johns Hopkins Hospital, Baltimore, Maryland 21205.
Insights
Verapamil effectively controlled blood pressure and reduced left ventricular mass in elderly patients with hypertension. This regression positively impacted diastolic function and cardiac performance.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Left ventricular hypertrophy (LVH) is a recognized risk factor for coronary disease in the elderly.
- The impact of antihypertensive agents on LVH regression and subsequent cardiac function in older adults is not well understood.
Purpose of the Study:
- To compare verapamil and atenolol in controlling blood pressure and inducing LVH regression in elderly hypertensives.
- To assess the effect of LVH regression on diastolic filling and cardiac performance.
Main Methods:
- 42 hypertensive patients (≥60 years) underwent echocardiography and blood pool scans.
- Randomized trial comparing verapamil and atenolol, with chlorthalidone as add-on therapy.
- Measurements repeated after 6 months and medication withdrawal.
Main Results:
- Verapamil achieved blood pressure control alone in 18 patients; atenolol alone in 8 (p < 0.01).
- LV mass regression and improvements in diastolic filling and ejection fraction were observed with verapamil.
Conclusions:
- Verapamil demonstrates superior efficacy in blood pressure control and LVH regression compared to atenolol in the elderly.
- LVH regression induced by verapamil improves diastolic relaxation and cardiac output in older hypertensive patients.
Abstract:
It is now recognized that left ventricular hypertrophy (LVH), often associated with hypertension, is itself a risk factor for coronary disease in the elderly. Although many agents are capable of controlling blood pressure, the ability of these agents to induce regression of left ventricular (LV) mass, and the effect of regression on diastolic relaxation and contractile indices in the elderly are less well known. Our study compared the ability of the calcium blocker, verapamil, and the beta-blocker, atenolol, to both control blood pressure (BP) and to induce regression of LV mass in older hypertensives. In addition, the influence of regression on resting diastolic filling and on cardiac output and ejection fraction during rest and mild upright bicycle exercise were determined. Forty-two hypertensives 60 years of age or above, without evidence of ischemic disease underwent 2-D echocardiographic evaluation of LV mass and gated blood pool scan determination of early diastolic filling, cardiac output and ejection fraction. They were then randomized to receive verapamil or atenolol during a four-week titration period so as to achieve a BP of less than 160/90 mm Hg. If BP was not controlled with either agent, chlorthalidone was added. Individuals whose BP was controlled continued on the protocol for six months. At that time, the echocardiographic and gated blood pool studies were repeated both on and after subsequent withdrawal of the study medications. Twenty-one patients were randomized to receive verapamil and 21 patients to receive atenolol. Blood pressure control was achieved with verapamil alone in 18 patients, but with atenolol alone in only 8 patients (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)