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Effect of therapy on left ventricular function in hypertension
Insights
Aggressive blood pressure reduction in hypertensive patients temporarily improved cardiac function indices like ejection fraction. Long-term treatment also reduced left ventricular mass, indicating partial reversibility of hypertension-induced cardiac changes.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Physiology
Background:
- Untreated hypertension leads to detrimental cardiac structural and functional changes.
- Left ventricular hypertrophy is a common consequence of sustained high blood pressure.
Purpose of the Study:
- To investigate the impact of aggressive antihypertensive therapy on cardiac function and structure in hypertensive patients.
- To assess the reversibility of hypertension-induced cardiac remodeling.
Main Methods:
- Twelve untreated hypertensive patients underwent echocardiography before and at 2 weeks, 3 months, and 6 months after aggressive antihypertensive treatment.
- Blood pressure was monitored throughout the 6-month treatment period.
Main Results:
- Blood pressure significantly decreased from 171.8/119.7 mmHg to an average of 142/98 mmHg over 6 months.
- Ejection fraction and mean velocity of circumferential fibre shortening temporarily increased within 2 weeks and at 3 months, returning to baseline by 6 months.
- Significant reductions in left ventricular end-systolic and end-diastolic dimensions were observed, along with a decrease in left ventricular mass index.
Conclusions:
- Early stages of blood pressure reduction with antihypertensive agents cause a transient improvement in ejection phase indices, likely due to afterload reduction.
- Long-term blood pressure control can partially reverse left ventricular mass increase associated with hypertension.
Abstract:
1. Twelve untreated hypertensive patients whose blood pressure was 171.8 +/- 5.5 mmHg systolic and 119.7 +/- 3.4 mmHg diastolic (mean +/- SEM) were treated aggressively with diuretics plus other antihypertensive agents. Echocardiograms were performed before, and 2 weeks, 3 months and 6 months after therapy. Blood pressures were lowered to an average of 142/98 mmHg over the 6 month period. 2. Mean velocity of circumferential fibre shortening rose from 1.1 +/- 0.09 to 1.3 +/- 0.06 diameters/s at 2 weeks and remained elevated at the end of 3 months (1.3 +/- 0.03 diameters/s) (P < 0.025), but returned to the control level in 6 months. Similarly, ejection fraction increased significantly during the same period from a control value of 65.1 +/- 4.4 to 73.4 +/- 1.8% (P < 0.025) and persisted in this range at 3 months. At 6 months the ejection fraction had returned to pretreatment levels. There were significant reductions in left ventricular end-systolic and end-diastolic dimensions. Left ventricular mass index decreased from 182.3 +/- 18.3 to 163.8 +/- 12.4 g/m2 after 6 months of therapy. 3. These results indicate that in the early stages of blood pressure reduction there is a temporary increase in ejection phase indices, probably related to afterload reduction. The reduction in the left ventricular mass index suggests that increased cardiac muscle mass due to elevated blood pressure may be partially reversible after long-term reduction in blood pressure.