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Effects of nifedipine-GITS on left ventricular mass and left ventricular filling
R A Phillips1, M Ardeljan, S Shimabukuro
1Department of Medicine, Mount Sinai Medical Center, New York, New York 10029.
Insights
Extended-release nifedipine significantly reduced severe hypertension and left ventricular mass in patients. This treatment improved cardiac function and reduced left ventricular hypertrophy prevalence over one year.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe hypertension is linked to adverse cardiac remodeling.
- Left ventricular hypertrophy (LVH) is a common complication of uncontrolled hypertension.
Purpose of the Study:
- To evaluate the effects of extended-release nifedipine (nifedipine-GITS) on blood pressure, left ventricular mass, and cardiac function in patients with severe hypertension.
- To assess changes in hormonal markers including plasma renin activity, atrial natriuretic peptide, and catecholamines.
Main Methods:
- Sixteen patients with diastolic blood pressure >= 120 mm Hg received nifedipine-GITS for 1 year.
- Serial assessments included blood pressure, left ventricular mass index, systolic function, diastolic filling, and plasma biomarkers.
- Echocardiography and blood sampling were used to monitor cardiac structure and function.
Main Results:
- Blood pressure significantly decreased from 200/122 mm Hg to 144/89 mm Hg (p < 0.0001).
- Left ventricular mass index reduced by 19% (p < 0.001) and LVH prevalence dropped from 63% to 25%.
- Left ventricular fractional shortening increased (p < 0.05), and early diastolic filling velocity improved (p = 0.07).
Conclusions:
- Extended-release nifedipine effectively controls severe hypertension and reverses left ventricular hypertrophy.
- The treatment leads to improvements in cardiac structure and function without altering the relationship between systolic function and stress.
- Sustained blood pressure reduction with nifedipine-GITS offers significant cardiovascular benefits.
Abstract:
Sixteen patients with initial diastolic blood pressure greater than or equal to 120 mm Hg were treated for 1 year with extended-release nifedipine [nifedipine-GITS (gastrointestinal therapeutic system)]. Serial changes in left ventricular mass index and associated alterations in left ventricular systolic function, left ventricular filling, plasma renin activity, atrial natriuretic peptide, and catecholamines were evaluated. Blood pressure was significantly reduced from 200 +/- 8/122 +/- 3 mm Hg (mean +/- SEM) to 144 +/- 5/89 +/- 2 mm Hg (p less than 0.0001) at 1 year. Eleven patients (69%) required only nifedipine-GITS for blood pressure control and 5 (31%) required the addition of chlorthalidone. After 6 months, the left ventricular mass index was significantly reduced by 19% from 121 +/- 8 to 96 +/- 7 g/m2 and this reduction was sustained at 1 year. Septal and posterior wall thicknesses were reduced from 13.4 +/- 0.1 to 11.2 +/- 0.04 mm and from 12.8 +/- 0.1 to 10.0 +/- 0.03 mm (p less than 0.001), respectively. Prevalence of left ventricular hypertrophy decreased from 63 to 25%. Left ventricular fractional shortening increased from 34 to 42% (p less than 0.05) and the relationship between fractional shortening and end-systolic stress did not change. Over the year of sustained blood pressure reduction, the peak velocity of early filling increased from 58 to 63 cm/s (p = 0.07), the peak velocity of late filling did not change, and the ratio of late to early peak velocity of left ventricular filling significantly decreased (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)