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Losartan reduces left ventricular hypertrophy proportionally to blood pressure reduction in hypertensives, but does

E Zakynthinos1, Ch Pierutsakos, K Konstantinidis

  • 1Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece. ezakynth@yahoo.com

Angiology
|November 18, 2004
PubMed

Insights

Losartan treatment reduced blood pressure and left ventricular hypertrophy (LVH) in hypertensive patients. However, LVH regression was linked to blood pressure reduction, not a direct drug effect on the heart, and diastolic function remained impaired.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • The impact of angiotensin II type I (AT1)-receptor blockade on left ventricular hypertrophy (LVH) is debated, with limited data on its effects on cardiac diastolic function.
  • Angiotensin-converting enzyme inhibition is known for its beneficial effects, but AT1-receptor blockers' role in managing LVH requires further clarification.

Purpose of the Study:

  • To investigate the effects of losartan, an AT1-receptor blocker, on left ventricular hypertrophy (LVH) and cardiac diastolic function in patients with moderate primary hypertension.
  • To determine if losartan treatment leads to regression of LVH and improves diastolic function in hypertensive individuals.

Main Methods:

  • Thirty-nine patients with hypertension and LVH underwent treatment with losartan (50-100 mg daily) for six months.
  • Transthoracic echocardiography was performed at baseline and after treatment to assess blood pressure, LVH parameters (including left ventricular mass index), and diastolic function (using Doppler parameters).
  • Patients were categorized into responders (mean blood pressure decrease > 5 mm Hg) and non-responders based on their blood pressure response to losartan.

Main Results:

  • Losartan treatment significantly reduced blood pressure (BP) and left ventricular mass index (LVMI) in the study group.
  • LVH regression was observed in patients who responded to losartan with a significant decrease in BP; non-responders showed no change in LVH.
  • Cardiac diastolic function parameters remained abnormal after six months of losartan treatment, and left atrial size increased.

Conclusions:

  • A six-month course of losartan effectively decreased blood pressure and reduced left ventricular hypertrophy in hypertensive patients.
  • The regression of LVH appeared to be primarily due to the reduction in hemodynamic load rather than a direct trophic effect of losartan on the myocardium.
  • Losartan treatment did not improve the abnormal cardiac diastolic function in this patient cohort.

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