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Comparison of the effects of isradipine and lisinopril on left ventricular structure and function in essential
E C Bielen1, R H Fagard, P J Lijnen
1Department of Pathophysiology, Faculty of Medicine, Catholic University of Leuven, Belgium.
Insights
Antihypertensive therapy significantly reduced left ventricular (LV) mass in patients with essential hypertension. This cardiac structure improvement was primarily linked to the reduction in systolic blood pressure (BP).
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is a global health concern impacting cardiac structure.
- The renin-angiotensin system plays a crucial role in blood pressure regulation and cardiac remodeling.
- Understanding the effects of different antihypertensive agents on cardiac parameters is vital.
Purpose of the Study:
- To compare the effects of different antihypertensive regimens on cardiac structure and function.
- To investigate the impact of agents targeting the renin-angiotensin system versus calcium antagonists.
- To determine the relationship between blood pressure reduction and left ventricular mass regression.
Main Methods:
- A 1-year randomized study involving 32 patients with essential hypertension.
- Treatment groups included a converting enzyme inhibitor (lisinopril) and a calcium antagonist (isradipine), with optional hydrochlorothiazide.
- Measurements included blood pressure, left ventricular mass, afterload, and Doppler echocardiography.
Main Results:
- Both treatment groups showed significant and similar blood pressure reduction.
- Left ventricular mass significantly decreased after 16 weeks and remained reduced, irrespective of the regimen.
- The regression of left ventricular mass correlated with the decrease in systolic blood pressure.
Conclusions:
- Antihypertensive therapy leads to regression of left ventricular mass.
- The reduction in systolic blood pressure is the primary driver of left ventricular mass regression.
- Cardiac function, including fractional shortening, improved similarly in both treatment groups.
Abstract:
The effects on cardiac structure and function of antihypertensive regimens with different effects on the renin-angiotensin system were compared. In a 1-year study, 32 patients with essential hypertension were randomized to treatment with either the converting enzyme inhibitor lisinopril or the calcium antagonist isradipine; hydrochlorothiazide could be added. Blood pressure (BP) decreased significantly (p less than 0.001) and similarly in the 2 treatment groups. Left ventricular (LV) mass was already significantly reduced after 16 weeks of treatment (p less than 0.001) and remained decreased thereafter, with no difference in the response to the 2 treatment regimens. The change in LV mass was related to the decrease in systolic BP for the total study group (p less than 0.001) and for each treatment group separately. During the 3-week run-out period on placebo, BP and LV mass increased again (p less than 0.01). Afterload decreased during active treatment (p less than 0.001), and fractional shortening of the LV internal diameter was significantly increased (p less than 0.01) to a similar extent in both groups. The ratio of peak mitral flow velocities during atrial contraction and early filling was reduced after 1 year of active treatment in the total study group (p less than 0.01); this change was similar in both groups. The data suggest that the regression of LV mass during antihypertensive therapy is mainly related to the decrease in systolic BP.