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Changes in left ventricular geometry during antihypertensive treatment

Massimo Salvetti1, Anna Paini1, Fabio Bertacchini1

  • 1Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy and Società Italiana dell'Ipertensione Arteriosa.

Pharmacological Research
|July 1, 2018
PubMed

Insights

Antihypertensive drugs can reduce left ventricular (LV) mass and improve cardiac geometry. Diuretics showed a lesser reduction in relative wall thickness (RWT) compared to other drug classes, suggesting varied impacts on cardiac remodeling.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Left ventricular (LV) mass reduction and improved geometry during antihypertensive treatment correlate with better prognosis.
  • While blood pressure-lowering drugs may reduce cardiac hypertrophy, their effects on LV mass and geometry vary.
  • Systematic evaluation of how different antihypertensive drug classes influence echocardiographic LV geometry is lacking.

Purpose of the Study:

  • To compare the effects of five major antihypertensive drug classes on relative wall thickness (RWT) changes.
  • To analyze the impact of diuretics (D), beta-blockers (BB), calcium channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACE-I), and angiotensin receptor blockers (ARBS) on LV geometry.

Main Methods:

  • Systematic literature search of MEDLINE and ISI Web of Sciences for randomized clinical trials.
  • Inclusion of studies evaluating LV mass and geometry at baseline and follow-up.
  • Pooled pairwise comparisons of RWT changes across five major drug classes and comparisons against combined other classes.

Main Results:

  • Fifty-three publications involving 7684 patients were analyzed.
  • A significant correlation was found between changes in LV mass and systolic blood pressure (SBP).
  • CCB demonstrated a greater reduction in LV mass compared to BB; RWT decreased with all drug classes except BB+D, with a lesser decrease observed with diuretics and sympatholytic drugs.

Conclusions:

  • Antihypertensive drug treatment can reduce LV mass and improve cardiac geometry.
  • Diuretics appear to be associated with a less pronounced reduction in RWT compared to other antihypertensive agents.
  • Further research is needed to fully elucidate the differential effects of antihypertensive drugs on cardiac remodeling.

Keywords:
Angiotensin receptor blockers (ARBS)Angiotensin-converting enzyme inhibitors (ACE-I)Beta-blockers (BB)Calcium channel blockers (CCB)Diuretics (D)EchocardiographyHypertensionLV remodelingLeft ventricular hypertrophyLeft ventricular mass (LVM)RegressionRelative Wall thickness (RWT)

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