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Progression of cardiac hypertrophy during long term calcium antagonist treatment with tiapamil
1Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Insights
Tiapamil effectively lowered blood pressure in patients with mild to moderate hypertension over 58 weeks. However, this calcium antagonist did not reduce left ventricular mass, despite its blood pressure-lowering effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension with left ventricular hypertrophy increases morbidity due to systolic and diastolic dysfunction.
- Regression of left ventricular hypertrophy is a key treatment goal for hypertension.
Purpose of the Study:
- To evaluate the effect of tiapamil on left ventricular mass in hypertensive patients.
- To assess tiapamil's ability to lower blood pressure and induce left ventricular hypertrophy regression.
Main Methods:
- An open study involving 20 adult patients with mild to moderate hypertension.
- Treatment with tiapamil for 58 weeks, monitoring blood pressure and left ventricular mass via echocardiography.
Main Results:
- Significant reduction in blood pressure from 166/105 mmHg to 142/88 mmHg.
- No significant change in posterior and interventricular septal wall thickness or left ventricular systolic dimension.
- Significant increase in left ventricular diastolic dimension (P < 0.05) and ejection fraction.
- Left ventricular mass significantly increased (P < 0.05).
- Mild decrease in blood glucose; other lab parameters unaffected.
- Side effects were mild and self-limiting.
Conclusions:
- Tiapamil is an effective and well-tolerated antihypertensive agent for mild to moderate hypertension.
- Tiapamil failed to induce regression of left ventricular mass despite significant blood pressure reduction.
Abstract:
Hypertension complicated by left ventricular hypertrophy is associated with increased morbidity as it leads to left ventricular systolic and diastolic dysfunction. Thus, in the treatment of hypertension, a desirable goal is the regression of left ventricular hypertrophy. Tiapamil, a new calcium antagonist, was evaluated in a 58 week open study to determine its effect on left ventricular mass in relation to its ability to lower blood pressure. Twenty adult patients with mild to moderate hypertension were entered into the study. Blood pressure was significantly reduced from 166 +/- 16/105 +/- 7 mmHg before treatment to 142 +/- 9/88 +/- 4 mmHg after 58 weeks. The posterior and interventricular septal wall thickness and left ventricular systolic dimension did not show any significant change by the end of the trial. On the other hand, left ventricular diastolic dimension, ejection fraction, and left ventricular mass increased significantly (P less than 0.05). Other laboratory parameters were not affected during treatment with the exception of a moderate decrease in the blood glucose. Side effects were mild and self-limiting, and no patients were withdrawn from the study. Although tiapamil appears to be an effective and well-tolerated drug in mild to moderate hypertension, it failed to reduce left ventricular mass.