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Cardiac effects of trandolapril in hypertension
1Echocardiographic Laboratory, Blood Pressure Research Clinic, Olympia, Wash.
Insights
Trandolapril effectively treats hypertension by reducing blood pressure and improving heart function. This study shows trandolapril reduces left ventricular hypertrophy and enhances diastolic function in hypertensive patients.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is a major risk factor for cardiovascular disease.
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- Assessing the impact of antihypertensive medications on cardiac structure and function is crucial.
Purpose of the Study:
- To evaluate the efficacy of trandolapril in reducing blood pressure and LVH.
- To assess the effects of trandolapril on left ventricular systolic and diastolic function.
- To determine if trandolapril improves left ventricular contractility in hypertensive patients.
Main Methods:
- 25 patients with essential hypertension received titrated doses of trandolapril (1-4 mg daily).
- Echocardiography was used to measure blood pressure, left ventricular mass index, relative wall thickness, and systolic/diastolic function.
- Left ventricular contractility was assessed using end-systolic wall stress and velocity of circumferential fiber shortening.
Main Results:
- Trandolapril significantly reduced supine diastolic blood pressure by 7.5% (p < 0.0001).
- Left ventricular mass index decreased by 23.2% (p < 0.0001) and relative wall thickness by 12.4% (p < 0.05).
- Left ventricular diastolic function (E/A ratio) improved in 60% of patients, while systolic function remained unchanged and contractility improved.
Conclusions:
- Trandolapril is effective in reducing blood pressure and regressing left ventricular hypertrophy in patients with essential hypertension.
- Trandolapril improves left ventricular diastolic function without compromising systolic function.
- The findings suggest trandolapril offers cardioprotective benefits in hypertensive individuals.
Abstract:
Baseline echocardiography was performed on 25 patients with essential hypertension and a supine diastolic blood pressure of 95 to 114 mm Hg while receiving placebo. Once-daily trandolapril was then titrated from 1 to 4 mg. After 3 months of therapy, supine diastolic blood pressure decreased by 7.5% (p < 0.0001). Left ventricular hypertrophy regressed as evidenced by a 23.2% (p < 0.0001) decrease in left ventricular mass index at 3 months and a 12.4% (p < 0.05) reduction of relative wall thickness at 6 months. Although afterload decreased by 12.4% (p < 0.05) at 3 months, left ventricular systolic function remained unchanged, whereas left ventricular contractility, which was assessed from the load-independent relationship of end-systolic wall stress to velocity of circumferential fiber shortening, improved. Left ventricular diastolic function (E/A ratio) improved in 15 of 25 patients with low baseline values from 0.96 +/- 0.14 to 1.18 +/- 0.25 (mean +/- SD, p < 0.0002) at 3 months. We conclude that trandolapril effectively reduces left ventricular hypertrophy and improves diastolic function in patients with hypertension while systolic function is preserved.