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Left ventricular systolic and diastolic function and mass before and after antihypertensive treatment in patients
Y Yoshitomi1, T Nishikimi, H Abe
1Division of Hypertension, National Cardiovascular Center, Osaka, Japan.
Insights
Antihypertensive treatment reduced blood pressure and improved diastolic function in hypertensive patients. Left ventricular hypertrophy regressed in moderate to severe hypertension, suggesting preserved intrinsic contractility.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular hypertrophy (LVH) is a common consequence of hypertension.
- The impact of antihypertensive treatment on LVH regression and cardiac function requires further investigation.
Purpose of the Study:
- To investigate the effects of antihypertensive treatment on left ventricular hypertrophy regression.
- To assess the impact on left ventricular systolic and diastolic function in hypertensive patients.
Main Methods:
- Echocardiographic assessment of 13 mild and 16 moderate to severe hypertension patients.
- Measurement of left ventricular mass index, wall thickness, and wall stress.
- Evaluation of diastolic filling indexes (E, A, A/E ratio) before and after treatment.
Main Results:
- Antihypertensive treatment significantly reduced blood pressure in both groups.
- Left ventricular mass index decreased significantly in the moderate to severe hypertension group.
- Peak early diastolic velocity (E) increased, and the A/E ratio decreased in both groups, indicating improved diastolic function.
Conclusions:
- Antihypertensive therapy promotes LVH regression and improves diastolic function.
- Intrinsic cardiac contractility appears unaffected by LVH or its regression.
- The observed diastolic improvements are primarily linked to blood pressure reduction.
Abstract:
The effects of antihypertensive treatment on regression of left ventricular hypertrophy and on left ventricular systolic and diastolic function were investigated echocardiographically in 13 untreated patients with mild hypertension (group I) and 16 untreated patients with moderate to severe hypertension (group II). The left ventricular mass index, left ventricular wall thickness, end-systolic left ventricular wall stress, and diastolic filling indexes before treatment were significantly higher in group II than in group I (p < 0.01). The blood pressure of both groups decreased significantly after antihypertensive treatment (mean duration of follow-up, 1.8 +/- 0.3 yr in group I and 2.0 +/- 0.4 yr in group II) (p < 0.01). The left ventricular mass index did not change in group I, whereas it decreased significantly in group II (p < 0.01). The relation between fractional shortening and end-systolic wall stress was similar in both groups before treatment and was unaltered by treatment in either group. After treatment, peak velocity in early diastole (E) significantly increased in both groups; however, peak velocity in late diastole (A) did not decrease in either group. The A/E ratio was significantly decreased in both groups and was significantly higher in group II than in group I (p < 0.01). In conclusion, the results suggest that intrinsic contractility may not be affected by left ventricular hypertrophy or regression of left ventricular hypertrophy. A/E ratio decreased after antihypertensive treatment in patients with mild hypertension mainly because of a decrease in blood pressure.