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Reversal of target-organ involvement in systemic hypertension: a pharmacologic experience
1Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121.
Insights
Systemic hypertension increases peripheral resistance, damaging organs like the heart and kidneys. Diltiazem, a calcium antagonist, effectively lowers blood pressure and may reverse cardiac hypertrophy.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pharmacology
Background:
- Systemic hypertension is characterized by elevated arterial pressure due to increased total peripheral resistance.
- Uncontrolled hypertension leads to impaired function of target organs, including the brain, heart, kidneys, and blood vessels.
Purpose of the Study:
- To discuss the effects of elevated arterial pressure on cardiac and renal function.
- To examine the impact of antihypertensive therapy on target-organ involvement.
- To evaluate the role of calcium antagonists, specifically diltiazem, in managing hypertension.
Main Methods:
- Review of existing studies on hypertension and its effects on target organs.
- Analysis of hemodynamic effects of calcium antagonists, focusing on diltiazem.
- Assessment of diltiazem's impact on left ventricular hypertrophy and renal hemodynamics.
Main Results:
- Elevated arterial pressure causes left ventricular hypertrophy and alters intrarenal hemodynamics.
- Diltiazem reduces total peripheral resistance and arterial pressure.
- Diltiazem is associated with regression of ventricular hypertrophy and maintains renal blood flow without excessive glomerular pressure increase.
Conclusions:
- Diltiazem demonstrates a beneficial role in treating essential hypertension.
- Calcium antagonists like diltiazem can mitigate cardiac and renal damage associated with hypertension.
Abstract:
Systemic hypertension is a disease manifested by a persistently elevated arterial pressure produced by an increased total peripheral resistance, which is more or less uniformly distributed throughout the component circulations. Unless pressure is reduced and maintained at controlled levels, it will be associated with impaired function of the primary target organs of the disease: brain, heart, kidneys and blood vessels. The effects of an elevated arterial pressure on heart and kidneys and the effects of antihypertensive therapy on target-organ involvement will be discussed. Cardiac involvement primarily relates to left ventricular hypertrophy and its regression with treatment, and in the kidney to altered intrarenal hemodynamics and effects of treatment. The role of calcium antagonists, primarily diltiazem, is discussed with reference to its hemodynamic effects on reducing total peripheral resistance and arterial pressure associated with regression of ventricular hypertrophy and maintenance of renal blood flow without inordinately increasing glomerular hydrostatic pressure. Studies suggest a beneficial role of diltiazem in the treatment of essential hypertension.