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Enalapril does not improve left ventricular diastolic dysfunction in young and mild hypertensives without concomitant
1Department of Internal Medicine, Taipei Medical College and Hospital, Taiwan.
Insights
Enalapril monotherapy did not improve left ventricular diastolic dysfunction (LVDD) in young, mild hypertensive patients. Echocardiogram results showed no significant changes in diastolic function after 24 months of treatment.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- Left ventricular diastolic dysfunction (LVDD) is a common complication of hypertension.
- Early intervention may prevent adverse cardiac remodeling and improve outcomes.
Purpose of the Study:
- To evaluate the efficacy of enalapril monotherapy in improving LVDD.
- To assess changes in diastolic function in young, mild hypertensive patients without left ventricular hypertrophy (LVH).
Main Methods:
- Fifty hypertensive patients (age <= 50 years, BP <= 160/100 mm Hg) with LVDD were treated with enalapril (mean 13 mg/day) for 24 months.
- Two-dimensional echocardiography was used to assess LVDD parameters at baseline and follow-up.
- Thirty-eight healthy subjects provided reference values.
Main Results:
- Enalapril treatment did not significantly alter peak early diastolic velocity (E), peak atrial velocity (A), or the E/A ratio.
- No significant changes were observed in the early to atrial velocity-time integral ratio.
- Left ventricular mass index and other echocardiographic parameters remained unchanged.
Conclusions:
- Long-term enalapril monotherapy did not improve LVDD in young, mild hypertensive patients without LVH.
- These findings suggest that enalapril may not be sufficient to reverse early diastolic dysfunction in this specific patient group.
Abstract:
The aim of the study was to determine whether enalapril monotherapy can improve left ventricular diastolic dysfunction (LVDD) in young and mild hypertensive patients without concomitant left ventricular hypertrophy (LVH). Fifty patients with hypertension < or = 160/100 mm Hg, aged < or = 50 years, normal two-dimensional echocardiographic (2-D echo) measurements, and LVDD were enrolled in this study. The LVDD was defined as a transmitral early (E) to atrial (A) peak velocity ratio of < or = 1. The mean documented hypertension was 6.3 years. The mean daily dose of enalapril was 13 mg. Baseline and 24-month follow-up echocardiograms were evaluated. Thirty-eight age- and sex-matched healthy subjects served to establish the normal reference values of 2-D echo measurements. After treatment, peak early diastolic velocity (E) (49 +/- 6 cm/sec v 48 +/- 10 cm/sec; P = not significant), peak atrial velocity (A) (62 +/- 9 cm/sec v 62 +/- 10 cm/sec; P = not significant), and E/A ratio (0.80 +/- 0.10 v 0.78 +/- 0.13; P = not significant) remained unchanged. Moreover, early to atrial velocity-time integral ratio (1.24 +/- 0.08 v 1.23 +/- 0.11; P = not significant) did not change. The left ventricular mass index, relative wall thickness, left ventricular end-systolic diameter, left atrial diameter, fractional shortening, heart rate, and body mass index did not show significant changes in all hypertensive patients. In conclusion, long-term antihypertensive therapy with enalapril did not lead to an improvement of LVDD in young and mild hypertension patients without concomitant LVH.