Left ventricular systolic function in relation to withdrawal of different pharmacological treatments in hypertensives with left ventricular hypertrophy
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M L Muiesan1, E Agabiti-Rosei, G Romanelli
1Clinica Medica, University of Brescia, Italy.
Insights
Essential hypertension patients typically have normal left ventricular systolic function. This function remains well-maintained even after left ventricular hypertrophy regression during treatment or upon treatment withdrawal.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Physiology
Background:
- Essential hypertension is often associated with left ventricular hypertrophy (LVH).
- The impact of LVH and its regression on left ventricular systolic function requires further elucidation.
- Assessing systolic function under various conditions is crucial for understanding hypertensive heart disease.
Purpose of the Study:
- To evaluate left ventricular mass index (LVMI) and systolic function in untreated essential hypertensive patients.
- To assess changes in LVMI and systolic function after antihypertensive treatment and during withdrawal.
- To determine the relationship between left ventricular end-systolic stress and fractional shortening in hypertensive individuals.
Main Methods:
- Cross-sectional and longitudinal study involving 74 untreated essential hypertensive patients and 26 controls.
- Measurements included left ventricular mass index (LVMI) and systolic function (end-systolic stress-fractional shortening relationship).
- Evaluations were performed at baseline, during treatment (6 and 12 months), and after treatment withdrawal.
Main Results:
- Untreated essential hypertensive patients generally exhibit normal left ventricular systolic function.
- Treatment led to a reduction in LVMI, while blood pressure increased upon withdrawal.
- The end-systolic stress-fractional shortening relationship remained consistent, indicating preserved systolic function post-treatment and upon withdrawal.
Conclusions:
- Left ventricular systolic function is typically normal in essential hypertension and is well-maintained.
- Regression of left ventricular hypertrophy does not compromise systolic function.
- Systolic function remains preserved at rest and during stress, even after treatment cessation.
Abstract:
We evaluated the left ventricular mass index (LVMI) and the functional response to cold pressor and handgrip tests in 74 untreated essential hypertensive patients and 26 age and sex-matched normals. The same measurements were repeated in 22 essential hypertensives after 6 and 12 months of treatment (captopril or nitrendipine, plus diuretic or beta-blocker in a few cases) and in 21 essential hypertensives after withdrawal of treatment, a reduction in the LVMI and a further increase in blood pressure. Left ventricular systolic function was evaluated by the relationship between left ventricular end-systolic stress and fractional shortening. Highly significant negative correlations, with similar slopes and intercepts, were found between end-systolic stress and fractional shortening under basal conditions, after regression of left ventricular hypertrophy and after withdrawal of treatment, both at rest and at the peak of stress tests. An examination of each point of the relation between end-systolic stress and fractional shortening showed that very few points were beyond the 95% prediction limits of the correlation obtained in normal volunteers. These results indicate that left ventricular systolic function is normal in most untreated essential hypertensives, and is usually well maintained after regression of left ventricular hypertrophy during long-term treatment as well as after withdrawal of treatment, both at rest and during an acutely induced afterload increase.