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Disparate effects of ACE-inhibitors and calcium antagonists on left ventricular structure and function in essential
F C Aepfelbacher1, F H Messerli, E Nunez
1Department of Internal Medicine, Ochsner Clinic, New Orleañs, LA 70121, USA.
Insights
Angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists equally reduce blood pressure in hypertension. However, ACE inhibitors more effectively decrease left ventricular mass and improve systolic function compared to calcium antagonists.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is a leading cause of cardiovascular disease.
- Left ventricular hypertrophy (LVH) is a significant predictor of adverse cardiac events.
- Angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists are primary treatments for hypertension and LVH.
Purpose of the Study:
- To compare the efficacy of ACE inhibitors versus calcium antagonists in reducing arterial pressure.
- To evaluate the impact of these drug classes on left ventricular structure and function in hypertensive patients.
- To determine differential effects on systolic and diastolic function and myocardial contractility.
Main Methods:
- A 4-week placebo run-in followed by treatment with 5 ACE inhibitors or 6 calcium antagonists in 96 hypertensive patients.
- Assessment of cardiac structure and function using 2D-guided M-mode echocardiography.
- Evaluation of arterial pressure, left ventricular mass index, wall thickness, diastolic function (peak filling rate, rapid filling duration), systolic performance (midwall fractional fibre shortening), and myocardial contractility.
Main Results:
- Both ACE inhibitors and calcium antagonists similarly reduced arterial pressure.
- ACE inhibitors demonstrated a greater reduction in posterior and septal wall thickness and left ventricular mass index.
- Systolic performance significantly improved with ACE inhibitors, while diastolic function improved similarly in both groups. Myocardial contractility decreased with calcium antagonists but not ACE inhibitors.
Conclusions:
- Both drug classes effectively lower arterial pressure and improve left ventricular diastolic filling.
- ACE inhibitors offer superior benefits in reducing left ventricular mass and enhancing systolic function in essential hypertension.
- The findings suggest ACE inhibitors may be more advantageous for managing hypertensive patients with left ventricular hypertrophy.
Abstract:
The present study was designed to compare the effects of angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists-the two drug classes thought to be most effective in reducing left ventricular hypertrophy-on arterial pressure, left ventricular structure and function in patients with essential hypertension. After a placebo period of 4 weeks, a population of 96 patients were treated either with one of five different ACE inhibitors or one of six different calcium antagonists. Cardiac structure and function was assessed by 2D-guided M-mode echocardiography. Whereas both drug classes lowered arterial pressure to the same extent, ACE inhibitors had a more pronounced effect on posterior and septal wall thickness and left ventricular mass index than calcium antagonists. Diastolic function, as measured by peak filling rate and duration of rapid filling, improved in both treatment groups to the same extent. However, systolic performance, as assessed by midwall fractional fibre shortening, was significantly improved by ACE inhibitors only. Myocardial contractility (end-systolic wall stress/end-systolic volume index) showed no significant change in the ACE inhibitor group but decreased after treatment with calcium antagonists. We conclude that both calcium antagonists and ACE inhibitors lower arterial pressure and increase left ventricular filling to the same extent. However, compared with calcium antagonists, ACE inhibitors had a more pronounced effect on left ventricular mass and improved systolic ventricular performance in patients with essential hypertension.