[Regression of hypertensive heart hypertrophy caused by chronic angiotensin-converting enzyme inhibition]

We wanted to determine whether an antihypertensive therapy with the angiotensin-converting enzyme inhibitor enalapril can induce regression of hypertensive hypertrophy. 13 patients with hypertensive left ventricular hypertrophy were treated with enalapril (10-40 mg/day) for 9 months. Left ventricular pump function, left ventricular hypertrophy and geometry were studied by echocardiography before and 3, 6 and 9 months after enalapril treatment had been established. Both a decrease in systolic arterial blood pressure as well as a reversal of myocardial hypertrophy was obtained. After 3 months' therapy, systolic arterial blood pressure dropped from 189 +/- 8 to 171 +/- 9 mm Hg and left ventricular muscle mass decreased from 210 +/- 13 to 196 +/- 8 g/m2. After 6 months' therapy, systolic arterial blood pressure decreased further to 154 +/- 7 mm Hg and left ventricular muscle mass to 181 +/- 8 g/m2. After another 3 months' therapy (after 9 months) no further decrease in systolic arterial blood pressure (159 +/- 9 mm Hg), and no further decrease in left ventricular muscle mass (189 +/- 8 g/m2) were obtained. After 9 months' therapy, reversal of myocardial hypertrophy was adequate in relation to the amount of blood pressure lowering. Due to unaltered ventricular loading conditions, as evidenced by identical systolic wall stress values, left ventricular pump function remained unchanged.