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Long-term antihypertensive treatment may induce normalization of left ventricular mass before complete regression of
E Agabiti-Rosei1, M L Muiesan, A Geri
1Clinica Medica, University of Brescia, Italy.
Insights
Long-term antihypertensive treatment significantly reduced blood pressure and left ventricular mass index (LVMI) in essential hypertension patients. LVMI normalized before arterial structural changes fully regressed, preserving systolic function.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Essential hypertension is linked to left ventricular hypertrophy and altered vascular resistance.
- Early detection and treatment are crucial for managing hypertensive complications.
Purpose of the Study:
- To evaluate the long-term effects of antihypertensive treatment on left ventricular mass index (LVMI) and arterial structural changes in essential hypertensive patients.
- To assess the impact of treatment on systolic function and hormonal markers.
Main Methods:
- 14 essential hypertensive patients received either captopril + hydrochlorothiazide or nitrendipine + atenolol for 12 months.
- Measurements included blood pressure, LVMI, forearm blood flow, plasma renin activity, catecholamines, and aldosterone.
- Minimal vascular resistance served as an index for arterial structural changes.
Main Results:
- Significant reductions in blood pressure, LVMI, and minimal vascular resistance were observed after 6 and 12 months of treatment.
- LVMI normalized in 9 patients, while minimal vascular resistance normalized in only 2.
- Plasma renin activity increased with captopril, but aldosterone and catecholamines remained unchanged. Left ventricular systolic function was preserved.
Conclusions:
- Long-term antihypertensive therapy effectively reduces LVMI and blood pressure in essential hypertension.
- LVMI normalization can occur before complete regression of arterial structural changes.
- Left ventricular systolic function is maintained during and after treatment, even under stress.
Abstract:
In 14 essential hypertensive patients, aged 26-59 years, blood pressure, left ventricular mass index (LVMI), systolic function (M-mode echo, two-dimensionally guided), post-ischaemic 'maximal' forearm blood flow (strain gauge venous occlusion plethysmography), plasma renin activity, plasma catecholamines and aldosterone were measured before and after 6 and 12 months of treatment (eight patients were given captopril, 100 mg/day, + hydrochlorothiazide 25 mg/day in five patients, and six patients were given nitrendipine, 20 mg/day, + atenolol 50 mg/day in four patients). Minimal vascular resistance (mean blood pressure/peak forearm blood flow) was taken as an index of arterial structural changes. After 6 months of treatment significant reductions in blood pressure (P less than 0.001), LVMI (P less than 0.001) and minimal vascular resistance were observed. After 12 months of treatment blood pressure, LVMI and minimal vascular resistance were further reduced. The LVMI was normalized in nine cases and the minimal vascular resistance in two cases only. Aldosterone and plasma catecholamines did not change, whereas plasma renin activity was increased during captopril only. Before and during treatment the left-ventricular shortening fraction in relation to end-systolic stress in each patient at rest, and at peak of handgrip and cold pressor tests, fell within the 95% confidence limits of correlation obtained in normals. Thus, in essential hypertensives long-term treatment can induce normalization of LVMI before complete regression of arterial structural changes in the forearm. Left ventricular systolic function is preserved after normalization of LVMI, both at rest and during stress.