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Ambulatory blood pressure and left ventricular changes during antihypertensive treatment: perindopril versus
A M Grandi1, M Bignotti, G Gaudio
1Department of Internal Medicine and Medical Therapy, University of Pavia, Italy.
Insights
Perindopril, an ACE inhibitor, more effectively reduced left ventricular hypertrophy (LVH) in hypertensive patients than isradipine, a calcium antagonist. Perindopril
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Hypertension frequently leads to left ventricular hypertrophy (LVH).
- LVH is a significant risk factor for cardiovascular events.
- Effective antihypertensive therapies are needed to regress LVH.
Purpose of the Study:
- To compare the effects of a calcium antagonist (isradipine) and an angiotensin-converting enzyme (ACE) inhibitor (perindopril) on LVH and blood pressure (BP) in hypertensive patients.
- To investigate the relationship between BP reduction and LVH regression.
- To assess the impact of these treatments on diastolic function.
Main Methods:
- 36 hypertensive patients with LVH were randomized into two groups.
- Group 1 received sustained-release isradipine; Group 2 received perindopril for 6 months.
- M-mode echocardiograms and 24-h ambulatory BP monitoring were used for assessments.
Main Results:
- Both isradipine and perindopril significantly reduced 24-h systolic and diastolic BP.
- Perindopril induced a significantly greater reduction in LV mass index compared to isradipine.
- Perindopril's LVH reduction was partly independent of BP decrease, suggesting a direct myocardial effect.
Conclusions:
- Both isradipine and perindopril effectively reduce LV hypertrophy and improve diastolic function in hypertensive patients.
- Perindopril demonstrates a superior effect in regressing LVH, potentially through mechanisms beyond BP reduction.
- These findings highlight the differential effects of ACE inhibitors and calcium antagonists on cardiac remodeling.
Abstract:
Using digitized M-mode echocardiograms and 24-h ambulatory blood pressure (BP) monitoring, we compared the effects on left ventricle (LV) and BP of 6-month treatment with a calcium antagonist or an angiotensin-converting enzyme (ACE) inhibitor in 36 hypertensive patients with LV hypertrophy (group 1, 18 subjects treated with sustained-release isradipine; group 2, 18 subjects treated with perindopril). At the basal evaluation, the two groups had comparable BP and LV parameters. After treatment, both groups showed a similar and significant reduction in 24-h, day- and night-systolic and diastolic BP (SBP, DBP). The reduction in LV mass index was greater (p < 0.01) in group 2. In group 1, percentage of decrease of LV mass correlated significantly with percentage of decrease in 24-h and daytime BP; this was not true of group 2. Together with the reduction in LV hypertrophy, there was a significant increase of peak lengthening rate of LV diameter that was greater (p < 0.01) in group 1. Both drugs can reduce LV hypertrophy and improve diastolic function. The reduction of hypertrophy induced by perindopril appears to be partly independent of BP decrease and therefore partly related to a direct action of perindopril on the myocardium.
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