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[Decreasing the antihypertensive dosage during longterm treatment and complete regression of left ventricular
I W Franz1, U Behr, R Ketelhut
1Klinik Wehrawald, Rehabilitationszentrum für Herz-Kreislauf- und Lungenerkrankungen der BfA.
Insights
Long-term antihypertensive treatment effectively reduces left ventricular hypertrophy (LVH) in patients. In approximately half of these patients, medication dosage can be reduced or discontinued, potentially aided by weight loss.
Area of Science:
- Cardiology
- Hypertension Research
- Internal Medicine
Background:
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- Increased cardiac muscle mass in LVH is associated with adverse cardiovascular outcomes.
- Effective antihypertensive therapy is crucial for managing LVH progression.
Purpose of the Study:
- To determine if antihypertensive treatment can lead to complete regression of LVH in hypertensive patients.
- To assess the potential for reducing medication dosage following LVH regression.
- To investigate the long-term effects of antihypertensive therapy on cardiac structure.
Main Methods:
- Prospective study of 22 previously untreated hypertensive patients with confirmed LVH.
- Patients received metoprolol, with hydrochlorothiazide added in some cases.
- Echocardiography was used to measure left ventricular muscle mass index (LVMI) over a 7-year period.
Main Results:
- Mean LVMI significantly decreased from 151 to 82 g/m2 over 7 years (P < 0.001).
- Complete LVH remission was observed in 21 out of 22 patients.
- Medication dosage reduction or discontinuation was possible in 11 patients, correlating with weight loss.
Conclusions:
- Sustained antihypertensive treatment effectively reverses LVH in nearly all hypertensive patients.
- Approximately 50% of patients may achieve reduced or discontinued medication needs.
- Weight loss appears to be a significant factor in facilitating LVH regression and medication reduction.
Aim Of Study:
To discover whether in hypertensives with left ventricular hypertrophy (LVH) the increased muscle mass will completely regress under antihypertensive treatment and drug dosage can in consequence be reduced.
Patients And Method:
Prospectively 22 previously untreated hypertensives (20 men, 2 women; mean age 43.6 +/- 9 years) with echocardiographically confirmed LVH were investigated. The observation period was 102 +/- 5 months. All patients initially received metoprolol, 100 mg daily, after 14 days 200 mg daily (additionally hydrochlorothiazide in five patients). In all patients the blood pressure became normal at rest and on exercise within 6 weeks.
Results:
After one year the mean left ventricular muscle mass index (LVMI) had fallen from 151 +/- 29 to 117 +/- 26 g/m2 (P < 0.001), and after 7 years to 82 +/- 14 g/m2 (P < 0.001; - 45.7%). Complete remission of LVH was demonstrated in 21 Patients. The drug dosage could either be reduced or the drug completely discontinued in 11 patients (group 1): after 102 +/- 5 months four patients took no drug, while seven were on 100 mg metoprolol. This was not possible in the other 11 patients (group 2), five of whom had been on both metoprolol and hydrochlorothiazide. The two groups differed with respect to loss of body weight (group 1: from 81.+/- 12 to 79.1 +/- 13 kg; P < 0.05; group 2: 85.7 +/- 8 to 88.1 +/- 10 kg; P < 0.05), but not regarding reduction of LVMI and blood pressure.
Conclusion:
Antihypertensive treatment for several years leads to regression in LVH in nearly all patients. In half of them the drug dosage can be reduced or the drug even discontinued. Weight loss may play an important part in this development.