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Regression of left ventricular hypertrophy and systolic function in hypertensive patients during long-term treatment
V Coto1, M Cocozza, U Oliviero
1II Medical School, University of Naples, Italy.
Insights
Ketanserin effectively reduces left ventricular hypertrophy (LVH) in hypertensive patients. This regression of LVH does not impair systolic heart function, even during exercise.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Antihypertensive therapy can regress left ventricular hypertrophy (LVH).
- The impact of LVH reversal on cardiac function, especially under stress, is not fully understood.
Purpose of the Study:
- To investigate the long-term effects of ketanserin on LVH regression and systolic function in hypertensive patients.
- To assess if ketanserin-induced LVH reversal affects the heart's ability to handle exercise or hypertension recurrence.
Main Methods:
- 13 untreated hypertensive patients with LVH and normal ejection fraction received ketanserin.
- Echocardiography measured LV dimensions, wall thickness, and mass over 12 months.
- Radionuclide angiocardiography assessed ejection fraction at rest and during exercise.
Main Results:
- Ketanserin significantly reduced mean arterial pressure and LV mass index.
- Posterior and septum wall thicknesses decreased, with LV mass index reducing by 16% after 12 months.
- LVH regression was not associated with impaired resting or exercise ejection fraction.
Conclusions:
- Ketanserin effectively induces LVH regression in hypertensive patients.
- The regression of LVH achieved with ketanserin does not compromise systolic cardiac function.
Abstract:
It is now generally accepted that antihypertensive therapy can induce regression of left ventricular hypertrophy (LVH) in hypertensive subjects. However, the influence of LVH reversal on both the systolic and diastolic functions, and particularly the ability of the heart to meet sudden overloads caused by exercise and/or recurrence of hypertension, remain unanswered questions. The long-term effects of ketanserin, a selective serotonin S2-receptor antagonist with additional alpha 1-adrenergic blocking properties, on LVH and systolic function were studied in 13 untreated subjects (age range 35-55 years) with mild-to-moderate essential hypertension, echocardiographic evidence of LVH, and normal ejection fraction. Blood pressure values and echocardiographic measurements of dimensions, wall thicknesses, and indices of LV mass were determined before and after 3, 6, and 12 months treatment; ejection fractions at rest and during exercise were evaluated by equilibrium multigated radionuclide angiocardiography at baseline and after 12 months of therapy. Mean arterial pressure was significantly reduced from the first month of treatment (p less than 0.001) and remained well controlled up to the end of the trial. Both posterior and septum wall thicknesses decreased after 3 months of therapy and remained stable throughout the whole study period. LV mass index decreased from a mean +/- SD of 187.7 +/- 47.6 g/m2 to a mean of 157.81 +/- 31.63 g/m2 (p less than 0.01) at the third month, reaching greater decreases after 6 months (156.05 +/- 31.00 g/m2) and after 12 months (153.21 +/- 28.80 g/m2) of treatment. A significant correlation was found between LV mass and posterior wall thickness at the different observation times in the study. Finally, the regression of LVH at the end of therapy was not associated with impairment of systolic function, as assessed by measurements of ejection fraction at rest and during exercise.