The effect of cilazapril on systolic and diastolic cardiac function in hypertensive patients

Diastolic function may be impaired in hypertensives even before alterations occur in systolic function. We studied the effect of a single dose of cilazapril, 5 mg orally, on systolic and diastolic cardiac function in 20 hypertensive patients using a double-blind crossover placebo controlled design. All patients had mild to moderate concentric left ventricular hypertrophy, preserved systolic function and long standing hypertension (for a period of 11.9 +/- 9.0 years). Radionuclide scintigraphy was performed with cilazapril and placebo, given one week apart. A two-week washout period of all cardioactive drugs preceded the study. Within one hour of oral administration of cilazapril blood pressure was significantly lowered. The absolute time to peak filling rate of the left ventricle, as well as the time to peak filling rate expressed as a percentage of diastole, were reduced from 176 +/- 34 to 158 +/- 33 msec (P less than 0.01) and from 46 +/- 10% to 37 +/- 8% (P less than 0.02) (reduction by 9% and 18.4%, respectively). Heart rate, left and right ventricular ejection fraction and peak filling rate was not significantly altered. Placebo had no significant effect. The effect of cilazapril is most probably related to afterload reduction. In conclusion; cilazapril seems to improve diastolic cardiac function in hypertensive patients. Long-term therapy may result in improvement of other, less sensitive indices of diastolic dysfunction.