Regression of left ventricular hypertrophy in hypertensive patients: responses to exercise by antihypertensive treatment
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1Department of Medicine, Wakayama Medical College, Japan.
Insights
Different antihypertensive drugs affect left ventricular hypertrophy (LVH) regression and exercise responses differently. Angiotensin converting enzyme inhibitors and beta-blockers significantly reduced LV mass, while all treatments improved electrocardiographic signs of LVH.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Left ventricular (LV) hypertrophy is a common complication of essential hypertension.
- Antihypertensive therapies aim to reduce cardiovascular risk by targeting blood pressure and associated cardiac remodeling.
- Understanding differential effects of drug classes on LVH regression and hemodynamic responses is crucial for optimal patient management.
Purpose of the Study:
- To compare the effects of beta-blockade, calcium channel blockade, and angiotensin-converting enzyme inhibition (ACEI) on echocardiographic and electrocardiographic markers of LV hypertrophy.
- To evaluate the impact of these antihypertensive treatments on hemodynamic and sympathetic nervous system responses during exercise.
Main Methods:
- Seventy-five patients with essential hypertension were enrolled.
- Echocardiography and electrocardiography were used to assess LV mass and hypertrophy criteria.
- Hemodynamic parameters and plasma norepinephrine levels were measured during submaximal exercise before and after treatment.
Main Results:
- Beta-blockade and ACEI significantly reduced LV mass, while calcium channel blockers showed a smaller reduction.
- All three treatment groups demonstrated a reduction in QRS high voltage criteria for LV hypertrophy on ECG.
- Captopril (ACEI) attenuated pressor responses and suppressed norepinephrine increase during exercise, unlike metoprolol (beta-blocker) or nifedipine (calcium channel blocker).
Conclusions:
- Antihypertensive therapies, including beta-blockers, calcium channel blockers, and ACEI, can induce regression of left ventricular hypertrophy.
- The effects on exercise hemodynamics and sympathetic activity differ among these drug classes, despite similar blood pressure-lowering effects.
- Individual drug selection may influence the extent of LVH regression and the modulation of exercise-induced physiological responses.
Abstract:
The effects of various antihypertensive treatments on the echocardiographic and electrocardiographic findings of left ventricular (LV) hypertrophy were studied in 75 patients with essential hypertension. The hemodynamic effects of the therapy during exercise were also compared. LV mass by echocardiogram was significantly reduced by beta-blockade and angiotensin converting enzyme inhibition (ACEI), but only slightly reduced by Ca channel blockade. QRS high voltage criteria of LV hypertrophy by electrocardiogram were reduced by all 3 of these antihypertensive treatments. At submaximal exercise, the pressor responses were attenuated by captopril, but not influenced by metoprolol or nifedipine. The increase in plasma norepinephrine by exercise was significantly suppressed after captopril, but was somewhat augmented after metoprolol or nifedipine. These observations indicate that the responses of hemodynamics and sympathetic nervous activity to exercise are different after the treatment by beta-blocker, Ca channel blocker or ACEI, in spite of the equal antihypertensive effect. However, it is suggested that the regression of LV hypertrophy might be induced by antihypertensive therapy, though the different grade by the individual drug.