Physical performance is preserved after regression of left ventricular hypertrophy

Reversal of left ventricular hypertrophy has been shown to improve left ventricular diastolic function in elderly patients with hypertension, but little is known about whether this affects physical performance. Left ventricular mass, cardiac function at rest and during submaximal exercise, and physical performance were assessed in 38 elderly patients with hypertension with left ventricular hypertrophy and normal systolic function before and after 8 and 14 months of therapy with amlodipine or hydrochlorothiazide or both. Blood pressure control was achieved with amlodipine in 18 patients, with hydrochlorothiazide in seven, and with the combination of these drugs in 13. Left ventricular mass index was similarly reduced from approximately 150 to approximately 100 g/m2 at 14 months' in each treatment group. Systolic function was maintained with the three treatment regimens, whereas similar decreases in time to peak filling rate and increases in first-third filling fraction occurred both at rest and during submaximal exercise after 8 months and further after 14 months of therapy. Exercise capacity did not significantly change in the group as a whole, but individual changes in peak oxygen uptake at the end of treatment correlated significantly with the decrease in time to peak filling rate during submaximal exercise (r = -0.49; p < 0.01). It is concluded that long-term blood pressure control with amlodipine or hydrochlorothiazide or both is associated with significant reductions in left ventricular mass and improved diastolic function in elderly patients with hypertension with left ventricular hypertrophy. Despite this reduction in left ventricular mass, left ventricular systolic function and physical performance are well preserved during submaximal exercise.