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The effects of antihypertensive therapy on left ventricular mass in elderly patients
S P Schulman1, J L Weiss, L C Becker
1Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
Insights
Verapamil effectively reduced left ventricular mass in elderly hypertensive patients, improving diastolic filling without affecting systolic function. Atenolol did not significantly reduce left ventricular mass.
Area of Science:
- Cardiology
- Gerontology
- Pharmacology
Background:
- Left ventricular mass reduction during hypertension treatment is inconsistent.
- The impact of left ventricular mass changes on cardiac function remains unclear.
Purpose of the Study:
- To evaluate verapamil and atenolol's efficacy in reducing left ventricular mass in elderly hypertensive patients.
- To assess the effects of left ventricular mass reduction on cardiac function.
Main Methods:
- A six-month randomized trial involving 42 elderly hypertensive patients.
- Comparison of verapamil versus atenolol treatment.
- Assessment of blood pressure, left ventricular mass index, and cardiac function parameters.
Main Results:
- Both verapamil and atenolol lowered blood pressure, but atenolol required more frequent addition of chlorthalidone.
- Verapamil significantly reduced left ventricular mass index; atenolol did not.
- Reduced left ventricular mass correlated with improved diastolic filling, while systolic function remained unchanged.
Conclusions:
- Left ventricular mass can be reduced in elderly hypertensive patients with mild hypertrophy via antihypertensive therapy.
- Verapamil is more effective than atenolol in reducing left ventricular mass and improving diastolic function.
- Antihypertensive therapy-induced left ventricular mass reduction does not impair systolic function.
Abstract:
Left ventricular mass sometimes decreases during treatment of hypertension, but this response is inconsistent and its effects on left ventricular function are unknown. In a six-month randomized trial, we studied the ability of verapamil and atenolol to reduce left ventricular mass in 42 elderly patients with hypertension and the effects of this reduction in mass on cardiac function. The mean blood pressure (+/- SE) decreased in both the group that received verapamil (from 171.4 +/- 3.2/93.0 +/- 2.5 mm Hg to 142.9 +/- 2.8/79.0 +/- 2.0 mm Hg) and the group that received atenolol (from 179.6 +/- 4.6/98.5 +/- 2.4 mm Hg to 148.1 +/- 3.3/83.4 +/- 1.2 mm Hg), but the atenolol-treated patients more frequently required the addition of chlorthalidone to achieve blood-pressure reduction (P less than 0.01). Verapamil resulted in a reduction in the left-ventricular-mass index from 104 +/- 5 g per square meter of body-surface area to 85 +/- 5 g per square meter (P less than 0.01). Atenolol did not produce a reduction in the left-ventricular-mass index (109 +/- 9 g per square meter before treatment vs. 112 +/- 10 g per square meter after treatment). Two weeks after the withdrawal of antihypertensive therapy, blood pressure returned to pretreatment values. Nevertheless, in patients whose left ventricular mass had decreased, two measures of diastolic filling, the peak diastolic filling rate to the peak ejection rate, were significantly higher than before treatment (2.42 +/- 0.2 vs. 3.31 +/- 0.4 [P less than 0.05] and 0.61 +/- 0.03 to 0.85 +/- 0.05 [P less than 0.05], respectively). Diastolic filling was unchanged in the group that had no reduction in left ventricular mass. Cardiac output and the ejection fraction at rest and during mild exercise were unchanged in both groups as compared with baseline values. We conclude that left ventricular mass can be reduced in elderly patients with hypertension and mild ventricular hypertrophy who receive antihypertensive therapy. Reduction occurs more frequently with verapamil than with atenolol therapy, increases diastolic filling, and does not impair systolic function.