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Effects of nicardipine on left ventricular hemodynamic patterns in systemic hypertension
G de Simone1, G Costantino, S Soro
1Institute of Internal Medicine and Metabolic Diseases, 2nd Medical School, University of Naples, Italy.
Insights
Nicardipine effectively lowers blood pressure (BP) and improves cardiac function in hypertensive patients. These benefits, including reduced left ventricular (LV) mass, are most pronounced in patients with concentric hypertrophy.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Systemic hypertension leads to left ventricular (LV) structural and functional changes.
- Understanding the impact of antihypertensive medications on cardiac mechanics is crucial for patient management.
Purpose of the Study:
- To evaluate the effects of nicardipine on LV function and structure in hypertensive patients.
- To assess changes in myocardial afterload, systolic and diastolic function, and LV mass.
Main Methods:
- A double-blind study involving 17 hypertensive patients (11 nicardipine, 6 placebo) over two months.
- M-mode echocardiography was used to assess LV parameters, including end-systolic stress, fractional shortening, and LV mass.
- Patients were analyzed based on their LV hypertrophy pattern (concentric vs. eccentric).
Main Results:
- Nicardipine significantly reduced blood pressure (BP), myocardial afterload, and improved systolic function (fractional shortening).
- A 5% reduction in LV mass was observed with nicardipine treatment (P < .002).
- Diastolic function improved, particularly in patients with concentric hypertrophy, who also showed significant improvements in fractional shortening.
Conclusions:
- Nicardipine demonstrates significant effects on cardiac mechanics in systemic hypertension.
- The therapeutic effects vary based on the patient's left ventricular (LV) anatomical pattern.
- Improvement in LV function and reduction in LV mass are more predictable in patients with concentric hypertrophy.
Abstract:
To assess left ventricular (LV) functional and structural changes associated with the reduction of blood pressure (BP) values during nicardipine administration (60 mg daily, for two months), 17 hypertensive patients were studied by M-mode echocardiography, according to a double-blind design (11 with nicardipine and six with placebo). Decrease in BP induced by nicardipine was associated with decrease in myocardial afterload (end-systolic stress) (P less than .002) and improvement of systolic function (fractional shortening) (P less than .02), without changes in inotropic state (assessed by systolic BP/end-systolic dimension/posterior wall thickness ratio). At the end of trial, a 5% reduction was found in LV mass (P less than .002), whereas relative wall thickness did not change. Diastolic phase (assessed by relaxation time index, and the slope of EF tract of the anterior mitral valve leaflet) was improved (.01 less than P less than .001). Patients with concentric and eccentric hypertrophy were separately considered. Relaxation time index and fractional shortening were significantly improved only in patients with concentric hypertrophy (P less than .01), whereas in the other ones the effect of treatment was variable. These differences were probably due to different effects on preload in the two LV hemodynamic patterns. Thus, nicardipine shows powerful effects on cardiac mechanics in systemic hypertension, but these effects are different according to LV anatomic pattern. Only in the presence of concentric hypertrophy is it possible to foresee the improvement of LV function; LV hypertrophy can be also reduced in concentric hypertrophy, but in the short term the reduction is too small to assume pathophysiologic significance.