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Cardiac structure and function before and after acute and chronic verapamil administration in hypertensive patients
C Cuspidi1, L Sampieri, L Boselli
1Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italia.
Insights
Oral verapamil partially improves diastolic function acutely in hypertensive patients. Chronic verapamil treatment normalizes diastolic function by reducing left-ventricular mass and blood pressure.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension often leads to diastolic dysfunction.
- Left-ventricular (LV) hypertrophy is common in hypertension but absent in this study group.
- Diastolic function indices and LV dimensions/mass are key cardiovascular health indicators.
Purpose of the Study:
- To analyze acute and chronic effects of oral verapamil on diastolic function.
- To assess verapamil's impact on left-ventricular (LV) dimensions and mass in hypertensive patients.
- To evaluate verapamil's efficacy in normalizing diastolic filling indices.
Main Methods:
- 12 hypertensive patients without LV hypertrophy were studied.
- Double-blind, placebo-controlled acute administration of verapamil (160 mg).
- 12-month chronic treatment with verapamil (240 mg/day).
- Doppler echocardiography for diastolic function (E/A ratio).
- M-mode echocardiography for LV dimensions and mass.
Main Results:
- Baseline E/A ratio was lower in patients than controls (1.08 vs. 1.51).
- Acute verapamil decreased blood pressure and increased E/A ratio (to 1.26).
- Chronic verapamil normalized E/A ratio in responders (1.49) and reduced LV mass index (100 g/m2).
Conclusions:
- Acute verapamil offers partial improvement in diastolic function.
- Chronic verapamil treatment can normalize diastolic filling indices.
- Verapamil normalizes diastolic function by reducing LV mass and blood pressure in hypertensive patients.
Abstract:
The aim of this study has been to analyze the acute and chronic effects of oral verapamil on diastolic function indices, derived from Doppler echocardiography, and left-ventricular (LV) dimensions and mass, assessed by M-mode echocardiography, in hypertensive patients without LV hypertrophy. 12 patients with essential hypertension were studied in basal conditions and (1) after a single oral administration of verapamil 160 mg and placebo in a double-blind protocol and (2) over chronic treatment (12 months) with verapamil 240 mg/day. At baseline, the ratio between early and atrial-induced transmitral velocities (E/A ratio) was lower in patients than in 12 age-matched normal subjects (1.08 +/- 0.2 vs. 1.51 +/- 0.3, p less than 0.01). Acute verapamil administration significantly decreased arterial blood pressure (162 +/- 26/101 +/- 8 to 142 +/- 12/88 +/- 7 mm Hg, p less than 0.01 after 2 h) and increased the E/A ratio to 1.26 +/- 0.3 (p less than 0.05) after 3 h. No change in ventricular dimensions and heart rate was observed. After chronic therapy, we found a further increase in the E/A ratio in 10 responder patients (1.49 +/- 0.3, p less than 0.01). The LV mass index, that was higher than in normal subjects before the treatment (118 +/- 16 vs. 91 +/- 11 g/m2, p less than 0.01), was significantly reduced (100 +/- 17 g/m2, p less than 0.05 vs. basal, nonsignificant vs. normal subjects). Our results demonstrate that acute administration of verapamil only partially improves the abnormal indices of diastolic function in hypertensive patients, whereas chronic treatment, by reducing LV mass indices and blood pressure to normal values, can completely normalize the indices of LV diastolic filling.