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Effects of calcium antagonists on left ventricular structure and function
1Department of Cardiology and Cardiac Surgery, School of Medicine, Federico II University, Naples, Italy.
Insights
Calcium antagonists effectively reduce left ventricular mass in hypertensive patients. While not impacting resting systolic function, some improve performance in heart failure and reduce diastolic dysfunction when left ventricular mass decreases.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Antihypertensive treatment aims to reduce blood pressure and reverse left ventricular hypertrophy.
- Calcium antagonists are a class of drugs that can decrease left ventricular mass.
Purpose of the Study:
- To evaluate the effects of calcium antagonists on left ventricular hypertrophy, systolic function, and diastolic function in hypertensive patients.
- To compare the efficacy of different calcium antagonists, including verapamil, diltiazem, and dihydropyridines.
Main Methods:
- Review of existing literature on calcium antagonists and their effects on cardiac structure and function.
- Analysis of studies investigating verapamil, diltiazem, and various dihydropyridines (nifedipine, isradipine, lacidipine).
Main Results:
- Verapamil, diltiazem, and dihydropyridines are effective in reducing left ventricular mass.
- Calcium antagonists do not affect resting left ventricular systolic function in hypertensive patients without heart failure.
- Dihydropyridines improve systolic performance in hypertensive patients with heart failure.
- Intravenous verapamil improves diastolic dysfunction, but medium-term oral therapy with diltiazem or dihydropyridines does not.
- Reduction in left ventricular mass through antihypertensive therapy consistently improves diastolic properties.
Conclusions:
- Calcium antagonists are effective in reversing left ventricular hypertrophy.
- Their impact on systolic and diastolic function varies depending on the specific drug, patient condition (heart failure), and administration route.
- Achieving a reduction in left ventricular mass is key to improving diastolic function.
Abstract:
Effects of calcium antagonists on left ventricular hypertrophy: The goals of antihypertensive treatment are to lower systemic blood pressure and to reverse left ventricular hypertrophy. A number of different drugs can induce a decrease in left ventricular mass, some of which are calcium antagonists. In particular, verapamil, diltiazem and a number of dihydropyridines (nifedipine, isradipine, lacidipine) have proved effective in this respect. Left ventricular systolic function: Left ventricular systolic function is often normal at rest in patients with hypertension, but is quite commonly abnormal during exercise. Calcium antagonists therefore do not affect resting systolic function in this category of hypertensive patients. In contrast, in hypertensive patients with heart failure the administration of dihydropyridines improves systolic performance. Left ventricular diastolic function: Isovolumic relaxation and rapid filling are often impaired in patients with hypertension, with or without left ventricular hypertrophy. Verapamil is effective in abolishing this diastolic dysfunction when given intravenously; in contrast, medium-term therapy with calcium antagonists such as diltiazem or dihydropyridines does not improve left ventricular filling properties. However, when antihypertensive therapy achieves a reduction in left ventricular mass, a consistent improvement in diastolic properties occurs.