Long-term effect of antihypertensive therapy on left ventricular hypertrophy

We studied a total of 88 previously untreated hypertensives in order to determine the long-term effect of antihypertensive therapy on echocardiographically confirmed left ventricular hypertrophy. The drugs tested were the beta-blocker metoprolol (200 mg/day; 26 patients; mean age 43.9 years; follow-up 32 months), the calcium antagonist gallopamil (100-150 mg/day; 26 patients; mean age 49.7 years; follow-up 23 months) and a combination of 50 mg atenolol and 20 mg nifedipine (36 patients; mean age 44.2 years; follow-up 18 months). Despite similar reductions in resting blood pressure, each of the three therapeutical regimens had a different effect on the left ventricular mass index after 1 year of treatment: gallopamil reduced the index by 13.2% (170 +/- 49 to 148 +/- 41 g/m2, P less than 0.001), metoprolol by 21.9% (150 +/- 27 to 117 +/- 27 g/m2, P less than 0.001) and atenolol + nifedipine by 30.8% (148 +/- 33 to 103 +/- 21 g/m2, P less than 0.001). Similar results were obtained for interventricular septal (9.9, 15.4 and 20.7%, respectively) and posterior wall thicknesses (10.4, 16.7 and 24.1%, respectively). During the follow-up there was a further significant reduction in ventricular hypertrophy under all three treatments, but no significant changes in ventricular end-diastolic and end-systolic dimensions or in fractional shortening.