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Effects of angiotensin-converting enzyme inhibition on left ventricular geometric patterns in patients with essential
S De Castro1, F Pelliccia, D Cartoni
1Department of Clinical Medicine, La Sapienza University, Rome, Italy.
Insights
Quinapril therapy favorably alters left ventricular (LV) geometry in hypertension, reducing LV mass and wall thickness. These beneficial changes in LV remodeling are sustained and improve diastolic function.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors (ACEIs) are known to impact left ventricular (LV) remodeling.
- The specific effects of ACEIs on LV geometric patterns in hypertensive patients remain under investigation.
Purpose of the Study:
- To investigate the influence of quinapril therapy on left ventricular (LV) geometric patterns in patients with mild to moderate hypertension.
- To assess whether quinapril can favorably modify LV mass and the ratio of LV posterior wall thickness to diastolic diameter (RWT) in hypertensive individuals.
Main Methods:
- Prospective study of 122 hypertensive patients (mean age 51 years) treated with quinapril (10-40 mg/day) for over 2 years.
- Clinical evaluation and Doppler echocardiography performed at baseline and after treatment to assess LV mass and RWT.
- Patients categorized at baseline into four groups: normal LV, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy.
Main Results:
- Quinapril therapy led to a significant reduction in LV mass and RWT across all patient groups, including those with concentric hypertrophy and eccentric hypertrophy.
- Patients with concentric remodeling showed a significant decrease in RWT without an increase in LV mass.
- These favorable changes in LV geometry were maintained throughout the 2-year treatment period and correlated with improved LV diastolic function.
Conclusions:
- Quinapril effectively modifies the left ventricular (LV) geometric pattern in hypertensive patients, irrespective of baseline LV mass or RWT.
- The study demonstrates a favorable impact of quinapril on LV remodeling and diastolic function in hypertension.
- ACE inhibition with quinapril offers a therapeutic strategy to normalize adverse LV geometric patterns in hypertensive individuals.
Abstract:
Although angiotensin-converting enzyme inhibitors have been shown to affect left ventricular (LV) remodeling favorably in several conditions, it remains unclear whether they can influence LV geometric pattern in hypertension. To address this issue, 122 patients (71 men and 51 women; mean age = 51 +/- 10 years) with mild to moderate hypertension were studied prospectively. All underwent clinical evaluation and Doppler echocardiography at entry and more than 2 years of quinapril therapy (10-40 mg/day). According to either LV mass (normal if < 131 g/m2 for men or < 100 g/m2 for women) or the ratio of LV posterior wall thickness to diastolic diameter (RWT; normal if < 0.45) at baseline, 58 patients had normal mass and RWT, 18 patients had concentric remodelling (i.e., normal mass but increased RWT), 24 patients had eccentric hypertrophy (i.e., increased mass but normal RWT), and 22 patients had concentric hypertrophy (i.e., increase in both mass and RWT). After 6 months of quinapril therapy, all patients with normal left ventricles showed the maintenance of mass and RWT within normal limits. Patients with concentric remodeling showed no increase in mass but had a significant decrease in RWT. Patients with eccentric hypertrophy exhibited a significant reduction in mass with no substantial change in RWT. Patients with concentric hypertrophy had a significant reduction in both mass and RWT. Changes in LV mass and geometry were maintained during the 2-year period of treatment and were paralleled by improvements in Doppler indices of LV diastolic function in each group. It is concluded that quinapril, with its well-known effects on LV hypertrophy, modifies the LV geometric pattern of hypertensive patients favorably, regardless of the presence of an abnormal LV mass or RWT.