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Time course of complete normalization of left ventricular hypertrophy during long-term antihypertensive therapy with
I W Franz1, U Tönnesmann, J F Müller
1Klinik Wehrawald der BfA, Todtmoos, Germany.
Insights
This study shows that long-term ACE inhibitor treatment with quinapril effectively reverses left ventricular hypertrophy (LVH) and atrial enlargement. Complete normalization of LVH was achieved in over 90% of patients after 3 years, improving diastolic function.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Metanalyses suggest ACE inhibitors are superior to other first-line therapies for reducing left ventricular hypertrophy (LVH).
- Previous studies had limited treatment durations (approx. 6 months), necessitating longer-term investigation.
- The study aimed to determine the time course and extent of LVH reversal and normalization with ACE inhibition.
Purpose of the Study:
- To clarify the time course and degree of left ventricular hypertrophy (LVH) reversal.
- To determine the rate of complete normalization of LVH in patients treated with quinapril.
- To assess the impact of quinapril on atrial enlargement and diastolic function.
Main Methods:
- Prospective study of 26 previously untreated hypertensive patients with confirmed LVH.
- Treatment with quinapril (10-20 mg/day) or quinapril plus hydrochlorothiazide for 3 years.
- Evaluation of LVMI, relative wall thickness, left atrial size, fractional shortening, and diastolic function every 6 months via echocardiography and ambulatory blood pressure monitoring.
Main Results:
- Significant LVMI decrease of 17.5% after 7.5 months and 38.6% after 3 years (P < .001).
- Complete LVH reversal achieved in 90.5% of patients.
- Significant improvement in fractional shortening and E/A ratio, indicating enhanced cardiac function and diastolic function, respectively.
Conclusions:
- Long-term ACE inhibitor therapy with quinapril leads to significant and sustained reduction in LVH.
- Complete normalization of LV mass, left atrial size, and diastolic function is achievable with prolonged treatment.
- Antihypertensive therapy should aim for normalization of cardiac structure and function, not just reduction of LVH.
Abstract:
Metaanalyses have indicated that ACE inhibitors are more effective than other first-line therapies in reducing left ventricular hypertrophy (LVH). The average treatment period, however, was only approximately 6 months. The aim of the present study, therefore, was to clarify the time course and degree of reversal, and primarily to find out in how many patients a complete normalization of LVH can be achieved. Secondly, we sought to determine whether atrial enlargement can be reduced. Previously untreated hypertensive patients (mean age 46.3 +/- 9 years, eight women, 15 men) with echocardiographically confirmed LVH (left ventricular mass index ([LVMI] > 125 g/m2 for men; > 110 g/m2 for women) were prospectively treated over a 3-year treatment period with quinapril. Nine patients received 10 mg quinapril, 12 received 20 mg of quinapril daily, and five patients additionally received 25 mg hydrochlorothiazide. The time course of changes in LVMI, relative wall thickness, left atrial size, fractional shortening, and diastolic function was evaluated and ambulatory blood pressure monitoring (ABPM) and an exercise test were performed every 6 months. After a mean treatment period of only 7.5 months, there was a significant (P < .001), 17.5% decrease in LVMI with a further continuous and significant (P < .001) decrease of 38.6% after 38.3 +/- 3 months of therapy. In 90.5% of the patients a complete reversal of LVH was achieved. Fractional shortening increased significantly, the maximum being 14.6% after 38.3 +/- 3 months. The peak early/atrial velocity (E/A) ratio increased significantly (P < .01) after just 7.5 +/- 3.1 months with no further changes during follow-up. There seemed to be a parallel change with the decrease in left atrial dimension, where the most important decrease occurred after only 7.5 +/- 3.1 months (P < .01), with a further continuous reduction. Our study clearly shows that maximum reversal of LVH is a time-consuming process and that an essential goal of antihypertensive therapy should be not only a reduction in LVH but also a normalization in LV mass, left atrial size, and in diastolic dysfunction.