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Left ventricular diastolic function in hypertension: a 4 year follow-up study
J Mayet1, M Shahi, N R Poulter
1Department of Cardiology, St. Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, UK.
Insights
Long-term antihypertensive treatment significantly reduced left ventricular mass and improved diastolic function in hypertensive patients. Prolonged therapy may reverse left ventricular diastolic dysfunction in hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Hypertension is associated with left ventricular diastolic dysfunction.
- Long-term effects of antihypertensive treatment on diastolic function require further investigation.
Purpose of the Study:
- To assess the long-term effects of antihypertensive treatment on left ventricular diastolic function.
Main Methods:
- Followed 26 hypertensive patients for a mean of 4.25 years.
- Utilized two-dimensional and Doppler echocardiography to evaluate left ventricular mass, isovolumic relaxation time (IVRT), and E/A ratio.
- Assessed changes at 9 months and 4.25 years of therapy.
Main Results:
- Significant reduction in left ventricular mass index observed after 9 months and maintained over 4.25 years.
- No initial change in IVRT or E/A ratio at 9 months.
- Significant improvement in IVRT after 4.25 years, with a trend towards improved E/A ratio; 12/14 patients with abnormal baseline IVRT normalized.
Conclusions:
- Prolonged antihypertensive treatment can lead to significant improvements in left ventricular diastolic function.
- Left ventricular diastolic dysfunction associated with hypertension may be reversible with sustained antihypertensive therapy.
Abstract:
In order to assess the long term effects of antihypertensive treatment on left ventricular diastolic function, 26 hypertensive patients were followed up for a mean of 4.25 years with two-dimensional and Doppler echocardiography. A significant reduction in left ventricular mass index was first apparent after 9 months of therapy (mean (S.D.) 124 (22) vs. 114 (18) g/m2, P < 0.01), and this was maintained over the 4.25 year period (124 (22) vs. 117 (17) g/m2, p < 0.05). At 9 months there was no change in either isovolumic relaxation time (108 (26) vs. 108 (17) ms, P = N.S.) or left ventricular filling as assessed by peak flow velocity E/A ratio (0.94 (0.22) vs. 0.95 (0.27), P = N.S.). However, after 4.25 years there was a significant improvement in IVRT (108 (26) vs. 83 (11) ms, P < 0.01) with a trend towards an improved peak flow velocity E/A ratio, although this did not reach statistical significance (0.95 (0.27) vs. 1.02 (0.26), P = N.S.). Of the 14 patients who had an abnormal isovolumic relaxation time at baseline, 12 normalised and 2 improved. These findings suggest that left ventricular diastolic dysfunction in hypertension may be reversed by prolonged antihypertensive treatment.