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[Regression of left ventricular hypertrophy in hypertensive patients under long-term therapy with antihypertensive
I W Franz1, U Tönnesmann, U Behr
1Klinik Wehrawald der BfA, Todtmoos.
Insights
Long-term hypertension therapy significantly reduced left-ventricular hypertrophy (LVH) and improved heart contractility in patients. Most patients achieved normal left-ventricular muscle mass index (LVMI) after treatment with various antihypertensive drugs.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Hypertension is a major risk factor for left-ventricular hypertrophy (LVH).
- LVH is associated with increased cardiovascular morbidity and mortality.
- Effective long-term antihypertensive therapy is crucial for managing LVH.
Purpose of the Study:
- To investigate the long-term effects of different antihypertensive drug regimens on LVH.
- To assess changes in left-ventricular muscle mass index (LVMI) and myocardial contractility.
- To determine the proportion of patients achieving normalized LVMI with treatment.
Main Methods:
- 117 untreated hypertensive patients with echocardiographically proven LVH were enrolled.
- Patients received one of five different antihypertensive drug regimens for a mean of 38 months.
- Left-ventricular muscle mass index (LVMI), wall thickness, and fractional shortening were measured.
Main Results:
- All treatment groups showed significant reductions in LVMI, septal, and posterior-wall thickness.
- Mean LVMI decreased by 35-45% across the groups.
- 69.2% of patients achieved normal LVMI (<95 g/m2) by the end of the study.
- Myocardial contractility, measured by fractional shortening, significantly increased.
Conclusions:
- Long-term antihypertensive therapy effectively reduces LVH in patients with hypertension.
- Various drug combinations can normalize LVMI and improve cardiac function.
- These findings support the use of antihypertensive medications to manage LVH and improve cardiovascular outcomes.
Abstract:
The effect of long-term therapy of hypertension with antihypertensive drugs was investigated in 117 previously untreated patients (15 women, 102 men; mean age 46.4 +/- 9 years) with echocardiographically proven left-ventricular hypertrophy. 22 patients (group 1) received 100 mg/d Gallopamil, 25 (group 2) received 200 mg/d Metoprolol, 35 daily received both 50 mg Atenolol and 20 mg Nifedipine (group 3), 14 received daily 200 mg Acebutolol plus 20 mg Nifedipine (group 4), and 21 (group 5) 50 mg Atenolol plus 10 mg Enalapril daily. The treatment period lasted a mean of 38 (36.2-42.3) months. Left-ventricular muscle mass index (LVMI) as well as septal and posterior-wall thickness decreased significantly after 12.8 and 38.5 months (P less than 0.001). After a mean of 38.5 months LVMI had decreased by 36.7% in group 1, 35.1% in group 2, 42.3% in group 3, 45% in group 4 and 39.6% in group 5. LVMI was within normal range (less than or equal to 95 g/m2) in 81 of the 117 patients (69.2%) at the end of the treatment period. There was, however, no significant increase of the end-diastolic dimension of the left ventricle, but a significant increase of "fractional shortening" as a measure of myocardial contractility.