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Preserved ventricular pump function after a marked reduction of left ventricular mass
R Ketelhut1, I W Franz, U Behr
1Klinik Wehrawald, Todtmoos, Germany.
Insights
Long-term combination therapy with atenolol and enalapril effectively lowers blood pressure and significantly reduces left ventricular mass over time. Left ventricular mass decreased gradually throughout the 3-year study, while pump function remained preserved.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Antihypertensive drugs like ACE inhibitors and beta-blockers reduce ventricular hypertrophy.
- Limited data exists on the long-term effects and time course of combination therapy for hypertension-induced cardiac remodeling.
Purpose of the Study:
- To assess the long-term impact of combined angiotensin-converting enzyme inhibitor and beta-blocker therapy on arterial pressure and left ventricular mass.
- To investigate the relationship between blood pressure reduction and left ventricular mass changes during treatment.
Main Methods:
- Twenty-one patients with essential hypertension received daily low-dose atenolol (50 mg) and enalapril (10 mg) for 39 months.
- Echocardiography was used to measure cardiovascular parameters before treatment and at 6 and 39 months.
Main Results:
- Combination therapy significantly reduced resting (161/108 to 130/86 mm Hg) and exercise (192/112 to 167/95 mm Hg) arterial pressure.
- Significant decreases in interventricular septal thickness (28%), posterior wall thickness (29%), and left ventricular mass index (40%) were observed after 39 months.
- Blood pressure reductions were immediate, while left ventricular mass reduction was gradual and continuous over the treatment period.
Conclusions:
- Long-term atenolol and enalapril combination therapy effectively reduces arterial pressure and left ventricular mass in hypertensive patients.
- Left ventricular mass reduction is a gradual process that continues throughout long-term treatment.
- Despite significant reductions in left ventricular mass, cardiac pump function was well-preserved.
Objectives:
This study was designed to evaluate the long-term effects of combination therapy with an angiotensin-converting enzyme inhibitor and a beta-adrenergic blocking agent on the relation between the decrease in arterial pressure at rest and during exercise and the decrease in left ventricular mass.
Background:
A variety of antihypertensive drugs including angiotensin-converting enzyme inhibitors and beta-blockers have been shown to reduce ventricular hypertrophy, although little is known about combination therapy and the time course of such a reduction.
Methods:
Twenty-one patients with previously untreated essential hypertension were treated with a low dose combination of 50 mg of atenolol and 10 mg of enalapril once daily for 39 months. Cardiovascular findings were assessed by two-dimensionally guided M-mode echocardiography in the pretreatment phase and after 6 and 39 months of combination therapy.
Results:
Combination therapy reduced arterial pressure at rest from 161/108 to 130/86 mm Hg (p less than 0.001) and exercise arterial pressure at 100 W from 192/112 to 167/95 mm Hg (p less than 0.001). After 6 months of treatment, significant decreases in interventricular septal thickness (9%, p less than 0.001), posterior wall thickness (9%, p less than 0.001) and left ventricular mass index (16%, p less than 0.001) were demonstrated on the echocardiogram. After 39 months of therapy, reductions in these values were 28% (p less than 0.001), 29% (p less than 0.001) and 40% (p less than 0.001), respectively.
Conclusions:
Long-term treatment with combination therapy of atenolol and enalapril produced significant reductions in arterial pressure at rest and during exercise accompanied by a marked reduction of left ventricular mass. However, whereas arterial pressure decreased immediately and remained unchanged, left ventricular mass decreased more gradually and continued to decrease throughout the treatment period of greater than 3 years. Despite this marked reduction in left ventricular mass, left ventricular pump function was well preserved during rest and exercise.