Antihypertensive treatment in hypertensive patients with normal left ventricular mass is associated with left ventricular remodeling and improved diastolic function

Schulman, Douglas S.; Flores, Angel R.; Tugoen, John F.; Dianzumba, Sinda; Reichek, Nathaniel

doi:10.1016/s0002-9149(96)00227-5

Cited by 30 publications

(23 citation statements)

References 26 publications

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“…Likewise, improvement in diastolic function may represent one of the earliest markers (23-26) of end-organ damage reversal, and can occur even in the absence of LVH (27). The assumption that the observed changes in cardiac morphology and function seen in the present study relate predominantly to improvement in BP is reasonable because weight, which was the only index of lifestyle modification measured in the study, did not change significantly during the sixmonth observation period.…”

Section: Mechanisms Of Findingsmentioning

confidence: 52%

“…The tendency toward improvement in diastolic function parameters, even when measured LV mass change was minimal, likely reflects the influence of afterload reduction and pharmacological reduction of LV wall stress, which, over the short term (six months), may precede morphological changes. Schulman et al (27) treated BP from a mean of 165±22/98±9 mmHg to a final BP of 128±12/80±5 mmHg over a period of eight to 12 months in subjects without electrocardiographic signs of LVH and concluded that diastolic function improved without a significant change in LV mass. In the current study, a more rigorous lowering of BP over a shorter interval of time similarly showed improvements in diastolic function and a slight reduction in LV mass in the diuretic group where BP lowering was more effective.…”

Section: Mechanisms Of Findingsmentioning

confidence: 99%

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Successful treatment of hypertension accounts for improvements in markers of diastolic function − a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies

Ogunyankin

Day

2009

Canadian Journal of Cardiology

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C urrent hypertension treatment trials attribute relative differences in benefits associated with various treatment regimens to unique pharmacological benefits. These studies typically aim for a treatment systolic blood pressure (BP) goal of lower than 140 mmHg, rather than a deliberate aim to normalize BP (1-3). At study completion, up to 25% of treated subjects in these clinical trials ultimately have BP levels above the treatment goal, and a more substantial proportion of patients have a BP above the 'optimal' BP of lower than 120/80 mmHg. Epidemiological studies showed that, compared with optimal BP, 'high-normal' BP (130/85 mmHg to 139/89 mmHg) is associated with a higher risk-adjusted hazard ratio for cardiovascular disease (4), and that those with 'high-normal' BP have a RR of 2.3 for the development of cardiovascular disease in 10 years compared with those with 'optimal' BP (5). Hence, to unequivocally address the contributions of BACKGROUND: There is controversy regarding whether blood pressure (BP) medications have relevant therapeutic benefits beyond those due to lowering of BP. OBJECTIVE: To show that rapid successful treatment of hypertension leads to improvement in cardiac morphology and function regardless of the pharmacological agents used. METHODS: Hypertension was defined as an average 24 h ambulatory BP of higher than 135/85 mmHg in 38 subjects with a mean (± SD) age of 54±7 years. Patients were randomly assigned to treatment with a diureticbased (n=20) or a calcium channel blocker (CCB)-based (n=18) medication. All subjects were followed every two weeks, and similar additional medications were added until the BP was lower than 125/80 mmHg, then followed monthly for a total of six months. Echocardiography with tissue Doppler imaging was performed, and was repeated after six months of aggressive pharmacotherapy and lifestyle management. RESULTS: Baseline ambulatory BP monitoring and echocardiographic measures of diastolic function were similar between both treatment groups. Subjects received 3.5±1 pills and 11±2 follow-up visits. The average 24 h BP was reduced from 145/91 mmHg to 124/75 mmHg (P<0.001) in the CCB group. A greater lowering from 143/91 mmHg to 117/72 mmHg occurred in the diuretic group (P=0.02 for the difference between groups) at six months. There was significant improvement in tissue Doppler imaging diastolic function parameters in both groups, with a trend toward greater improvement in the diuretic group. The left ventricular mass/ height 2.7 index decreased from 40 g/m 2.7 to 37 g/m 2.7 in the diuretic group (P=0.02), whereas a nonsignificant change (41 g/m 2.7 to 42 g/m 2.7 ) occurred in the CCB group. CONCLUSIONS: Aggressive BP lowering is associated with improved left ventricular diastolic function and mass proportional to the extent of BP normalization.

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Section: Mechanisms Of Findingsmentioning

confidence: 52%

Section: Mechanisms Of Findingsmentioning

confidence: 99%

Successful treatment of hypertension accounts for improvements in markers of diastolic function − a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies

Ogunyankin

Day

2009

Canadian Journal of Cardiology

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“…25 The effect of CCBs on the prevention of left ventricular remodeling has also been reported. 26,27 Nifedipine causes an increase in nitric oxide, 26 which is produced when the vascular endothelium function improves, and has an antiproliferative action on vascular smooth muscles. 28 Therefore it suppresses the progression of atherosclerosis 29,30 and may be able to prevent cardiac events.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Calcium Channel Blocker in the Secondary Prevention of Myocardial Infarction-Retrospective Analysis of the 10-Year Prognosis of Coronary Thrombolysis-Treated Patients-

Tani

Watanabe

Nagao

et al. 2004

Circ J

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“…This corresponds well with what is found in dogs, 17 patients with aortic stenosis and aortic valve replacement, 29 and hypertensive patients without LV hypertrophy who had RWT regression. 16 Decrease in hemodynamic overload and remodeling of the myocardium have been associated with a decrease in muscle mass but a "relative" increase in fibrous tissue, which regresses less rapidly than myocardial tissue, necessitating 7 years for normalization of myocardial stiffness in one study. 29 …”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] Furthermore, studies in patients with diastolic dysfunction without concomitant LV hypertrophy have either shown no improvement 15 or improvement after multiyear antihypertensive treatment. 16 This might be a result of simultaneous changes in active LV relaxation and passive LV chamber stiffness. 17 To our knowledge, there are no large studies examining the effect of antihypertensive treatment on LV diastolic function in hypertensive patients.…”

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confidence: 99%

Change in Diastolic Left Ventricular Filling After One Year of Antihypertensive Treatment

et al. 2002

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Background-It is well established that hypertensive patients with left ventricular (LV) hypertrophy have impaired diastolic filling. However, the impact of antihypertensive treatment and LV mass reduction on LV diastolic filling remains unclear. Methods and Results-Echocardiograms were recorded in 728 hypertensive patients with ECG-verified LV hypertrophy (Cornell voltage-duration or Sokolow-Lyon) at baseline and after 1 year of blinded treatment with either losartan or atenolol-based regimen. Systolic and diastolic blood pressures (BP) were reduced on average 23/11 mm Hg; isovolumic relaxation time and E/A ratio became more normal, and LV inflow deceleration time prolonged (all PϽ0.001).Directionally opposite changes in isovolumic relaxation time (IVRT) and deceleration time indicate improvement in active LV relaxation and passive chamber stiffness during early diastole. Prevalences of normal LV filling increased, abnormal relaxation and pseudonormalization decreased, and restrictive filling pattern remained unchanged (PϽ0.05).Patients with reduction in LV mass had smaller left atrial diameter, shortened IVRT, increased E/A ratio, and prolonged LV inflow deceleration time (all PϽ0.001). Patients without LV mass reduction had no change in diastolic filling parameters (PϭNS). IVRT shortening was independently associated with reduction in LV mass. Increase in E/A ratio was independently associated with reduction in diastolic BP, and increase in the deceleration time was independently associated with reduced end-systolic relative wall thickness. Conclusions-Antihypertensive therapy resulting in LV mass or relative wall thickness regression is associated with significant improvement of diastolic filling parameters related to active relaxation and passive chamber stiffness compared with patients without regression, independent of BP reduction; however, abnormalities of diastolic LV filling remain common.

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Antihypertensive treatment in hypertensive patients with normal left ventricular mass is associated with left ventricular remodeling and improved diastolic function

Cited by 30 publications

References 26 publications

Successful treatment of hypertension accounts for improvements in markers of diastolic function − a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies

Successful treatment of hypertension accounts for improvements in markers of diastolic function − a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies

Efficacy of Calcium Channel Blocker in the Secondary Prevention of Myocardial Infarction-Retrospective Analysis of the 10-Year Prognosis of Coronary Thrombolysis-Treated Patients-

Change in Diastolic Left Ventricular Filling After One Year of Antihypertensive Treatment

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