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Antihypertensive treatment in hypertensive patients with normal left ventricular mass is associated with left
D S Schulman1, A R Flores, J Tugoen
1Department of Internal Medicine, Division of Cardiology, Medical College of Pennsylvania, Pittsburgh 15212, USA.
Insights
Antihypertensive therapy improved diastolic function in patients with hypertension but no left ventricular hypertrophy (LVH). Blood pressure control led to better peak filling rates and LV remodeling, showing diastolic function can improve without changes in LV mass.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Hypertension with left ventricular hypertrophy (LVH) shows regression with treatment.
- The impact of antihypertensive therapy on diastolic function in hypertensive patients without LVH is not well understood.
Purpose of the Study:
- To investigate the effects of antihypertensive therapy on left ventricular (LV) geometry and diastolic function in hypertensive patients without LVH.
Main Methods:
- 18 patients with mild to moderate hypertension and no significant LVH underwent baseline echocardiography and radionuclide angiography.
- Patients received 8-12 months of felodipine treatment, followed by restudies after withdrawal.
- Evaluated changes in blood pressure, LV mass index, relative wall thickness, ejection fraction, and diastolic filling rates.
Main Results:
- Blood pressure normalized with felodipine treatment (165/98 to 128/80 mm Hg).
- Rest peak filling rate increased significantly (2.63 to 3.11 EDV/sec), and exercise ejection fraction improved (64% to 71%).
- LV mass index remained unchanged, but relative wall thickness decreased, and LV end-diastolic dimension increased.
Conclusions:
- Antihypertensive therapy in hypertensive patients without LVH improves diastolic function, evidenced by increased peak filling rates.
- Therapy induces favorable LV remodeling, including decreased relative wall thickness, without altering LV mass.
- Diastolic function improvement is achievable independent of changes in LV mass.
Abstract:
Antihypertensive therapy in hypertensive patients with left ventricular (LV) hypertrophy causes hypertrophy regression and improved diastolic filling. Whether similar changes occur in hypertensive patients with diastolic dysfunction and no hypertrophy is unknown. We determined the effect of antihypertensive therapy of LV geometry and function in hypertensive patients without hypertrophy. In 18 mild to moderate hypertensive patients without significant hypertrophy, baseline echocardiograms and rest and exercise and radionuclide angiograms were performed. Subjects were treated for 8 to 12 months with the calcium channel blocker felodipine and then restudied 2 weeks after treatment withdrawal. Blood pressure normalized with treatment (165 +/- 22/98 +/- 9 to 128 +/- 12/80 +/- 5 mm Hg, p <0.001) and returned to pretreatment levels after therapy withdrawal. Rest ejection fraction and peak oxygen consumption and cardiac outputs were unchanged after treatment, but rest peak filling rate increased (2.63 +/- 0.57 to 3.11 +/- 0.95 end-diastolic volume/second, p <0.05). Ejection fraction increased with exercise only after treatment (64 +/- 5% at rest to 71 +/- 8% at peak exercise, p <0.05). LV mass index was unchanged (97 +/- 18 to 101 +/- 23 g/m2), but relative wall thickness declined (0.41 +/- 0.05 to 0.37 +/- 0.05) and LV end-diastolic dimension increased (4.9 +/- 0.4 to 5.2 +/- 0.4, p = 0.01). Blood pressures control in hypertensive patients without hypertrophy leads to improved peak filling rates and remodeling with decreased relative wall thickness. Improved diastolic function can occur without alterations in LV mass.