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Lack of effect of short-term lisinopril administration on left ventricular filling dynamics in hypertensive patients
C Cuspidi1, L Lonati, L Sampieri
1Istituto di Clinica Medica e Terapia Medica, Università di Milano, Italy.
Insights
Short-term use of lisinopril, an ACE inhibitor, did not improve altered left ventricular filling dynamics in hypertensive patients. Blood pressure was reduced, but diastolic function remained unchanged, indicating complex factors influence this condition.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Arterial hypertension is linked to impaired left ventricular filling dynamics.
- Altered diastolic patterns in hypertensive patients may affect cardiac function.
- Echocardiography and Doppler techniques assess left ventricular dynamics.
Purpose of the Study:
- To determine if short-term lisinopril administration improves left ventricular diastolic dynamics in hypertensive patients.
- To evaluate lisinopril's effects independently of changes in left ventricular mass.
- To assess diastolic function changes at rest and during isometric exercise.
Main Methods:
- Double-blind, cross-over study involving 39 hypertensive patients with an E/A ratio < 1.
- Patients received lisinopril (20 mg/day) or placebo for 4 weeks each.
- Echocardiography and Doppler assessed left ventricular filling parameters (E/A ratio, peak filling rates) at rest and during hand-grip test.
Main Results:
- Lisinopril significantly reduced systolic and diastolic blood pressure at rest and during exercise.
- No significant changes were observed in left ventricular structure or systolic function.
- Key left ventricular filling parameters (E velocity, A velocity, E/A ratio) showed no significant improvement.
Conclusions:
- Short-term afterload reduction with lisinopril does not improve altered left ventricular diastolic dynamics in hypertensive patients.
- Diastolic dysfunction is multifactorial, involving functional and structural elements.
- Antihypertensive therapy's short-term blood pressure reduction alone is insufficient to improve diastolic dysfunction.
Abstract:
Arterial hypertension may be associated with altered left ventricular filling dynamics. The specific goal of this study was to evaluate whether short-term administration of the ACE inhibitor lisinopril in hypertensive patients with an altered diastolic pattern induced an improvement of left ventricular dynamics, assessed by the echocardio-Doppler technique, independently of effects on left ventricular mass. In a double-blind cross-over study 39 essential hypertensive patients with a ratio of peak early to peak atrial velocity (E/A) < 1 were randomized, after a run-in period of 2 weeks without any antihypertensive treatment, to receive lisinopril (20 mg once a day) and placebo for 4 weeks, respectively. At the end of both the run-in and the treatment periods, blood pressure and heart rate were measured and an echocardio-Doppler examination was carried out. The echocardio-Doppler evaluation was performed both at rest and at the peak of a hand-grip test (3 min at 30% of maximal strength). Left ventricular dimensions were obtained from two-dimensionally guided M-mode tracings using the criteria of the American Society of Echocardiography. Left ventricular peak filling rates and filling rate integrals were measured by a pulsed Doppler technique. Lisinopril caused a significant reduction in systolic and diastolic blood pressure at rest (-13/-9 mmHg vs baseline values, p < 0.05; -6/-4 mmHg vs placebo values, p < 0.05) and during isometric exercise (-17/-9 mmHg vs baseline period, p < 0.05; -6/-5 mmHg vs placebo, p < 0.05). Lisinopril did not induce any significant change in left ventricular structure and systolic function. All the left ventricular filling parameters considered (E velocity, A velocity, E/A ratio) both at rest and during isometric exercise did not significantly differ after lisinopril treatment when compared to those obtained in basal conditions and after placebo administration. This double-blind cross-over study demonstrates that short-term afterload reduction induced by lisinopril does not modify altered diastolic dynamics in hypertensive patients. Diastolic dysfunction of the left ventricle is a complex process influenced by a number of functional and structural factors and apparently cannot be significantly improved by short-term blood pressure reduction by antihypertensive therapy.