Hypertension and Left Ventricular Hypertrophy: Is Drug Therapy Beneficial?

Eselin, Julie A.; Carter, Barry L.

doi:10.1002/j.1875-9114.1994.tb02790.x

Cited by 8 publications

(4 citation statements)

References 184 publications

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“…This observation is important, since one concern regarding the therapeutic value of LV hypertrophy regression is that it may result in a deterioration of diastolic function [2]. The data from this study indicated that diastolic function not only did not deteriorate in response to a significant reduction in LV mass index with mibefradil but actually improved.…”

Section: Discussionsupporting

confidence: 53%

“…Initially, this compensation may be beneficial. However, in the long term, it results in pathological changes in cardiac interstitial tissues and coronary vasculature [1,2]. LV hypertrophy secondary to essential hypertension occurs in 12-37% of patients, depending on the method used to detect LV hypertrophy (either electrocardiogram or echocardiograms) and populations studied [3,4].…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of the Effects of Mibefradil and Atenolol on Regression of Left Ventricular Hypertrophy in Hypertensive Patients

Höglund¹,

Cífková

Mimran

et al. 1998

Cardiology

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Objective: This study was designed to compare the effect of mibefradil, a selective T-type calcium channel antagonist, with the β-blocker atenolol on regression of left ventricular (LV) hypertrophy in hypertensive patients. Methods: In this multicenter, double-blind, active-controlled, randomized, parallel-group comparison, 66 patients with mild-to-moderate hypertension (sitting diastolic blood pressure, SDBP, 95–114 mm Hg) and LV mass index >102 g/m² for males and >88 g/m² for females were randomized to an initial treatment with 50 mg of either mibefradil or atenolol for 4 weeks. Doses were increased to 100 mg/day if blood pressure was not normalized to ≤90 mm Hg, and, if needed, 25 mg of hydrochlorothiazide was added. Treatment continued for a total of 24 weeks. LV hypertrophy was assessed by echocardiography, and trough SDBP and adverse events were recorded. Results: Treatment with mibefradil or atenolol resulted in decreases from baseline in LV mass index of 11.1% (p < 0.001) and 9.1% (p < 0.001), respectively. The treatment difference (mibefradil vs. atenolol) was not statistically significant. Reductions in SDBP with mibefradil and atenolol were 14.3 and 10.7 mm Hg, respectively, again not statistically significant. Both drugs were well tolerated; however, overall there were more potentially drug-related adverse events reported with atenolol (48.5%) than with mibefradil (24.2%). Conclusions: The reductions in LV hypertrophy and blood pressure achieved with mibefradil were larger but statistically equivalent to those with atenolol, but a lower overall incidence of treatment-related adverse events was seen in the mibefradil-treated patients.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

A Comparison of the Effects of Mibefradil and Atenolol on Regression of Left Ventricular Hypertrophy in Hypertensive Patients

Höglund¹,

Cífková

Mimran

et al. 1998

Cardiology

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“…Active drug therapy may reduce and delay the organ damage caused by hypertension (27). Excluding the impact of other factors, there are significant differences in LVH among patients receiving the same drug therapy (28,29). LVH is closely associated with the plasma levels of white blood cells in patients, which gives an indication of hypertension (17,19).…”

Section: Discussionmentioning

confidence: 99%

Association of white blood cell counts with left ventricular mass index in hypertensive patients undergoing anti-hypertensive drug therapy

Shi

Chu

et al. 2017

Experimental and Therapeutic Medicine

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Although studies using animal models have demonstrated that nonhemodynamic factors, including inflammatory cells and cytokines, contribute to left ventricular hypertrophy (LVH), there is little clinical data to confirm this association. Therefore in the present study, levels of circulating specific types of leukocyte were measured to determine the association between white blood cells and left ventricular mass index (LVMI) in hypertensive patients undergoing anti-hypertensive drug therapy. A total of 144 consecutive hypertensive patients taking anti-hypertensive drug therapy were enrolled in the current study. Subjects were divided into two groups: Those with normal geometry and those with left LVH. Total white blood cells and differentiated subtypes (neutrophils, lymphocytes, monocytes) were counted, and left ventricular end-diastolic diameter, left ventricular posterior wall thickness in diastole and inter-ventricular septal wall thickness in diastole were all measured. Analysis revealed a significant correlation between LVMI and total white blood cell levels (P=0.013). The percentage of LVH in the highest tertile of WBC was increased compared with the middle tertile (P=0.008). Furthermore, a significant correlation between the highest tertile of neutrophil counts and LVH was observed (P=0.039). However, no significant associations between LVMI and monocyte or lymphocyte counts were detected. Therefore, the current study determined that increased total white blood cell and neutrophil subtype counts were associated with LVMI in hypertensive patients undergoing anti-hypertensive drug therapy. They may provide convenient and useful markers for further risk appraisal of LVH caused by nonhemodynamic factors of hypertension.

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“…Echocardiographic studies have revealed that as many as 50% of asymptomatic patients who have mild to moderate hypertension have Zeft ventricular hypertrophy (LVH) [36,37]. Hemodynamic overload from long-standing systemic hypertension is the primary factor in the pathogenesis of LVH, but nonhemodynamic factors play a significant role as well.…”

Section: Effects On Left Ventricular Hypertrophymentioning

confidence: 99%

Calcium channel blockers and hypertension: Evolving perspectives?1996

Epstein

1997

Cardiovasc Drug Ther

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In recent years, calcium channel blockers (CCBs) have been used extensively in the United States and elsewhere as antihypertensive agents, and their availability has been an important advance in the management of hypertension. As antihypertensive agents, the CCBs thus appear considerably more versatile than most previous vasodilators. The available studies indicate that CCBs are metabolically neutral and do not exacerbate dyslipidemia or impair glucose tolerance. In contrast to diuretics and beta-blockers, CCBs do not appear to alter insulin sensitivity. The CCBs also differ from previous vasodilators because of their favorable accompanying effects on the heart and kidney. Despite the attributes of CCBs enumerated earlier, a number of recent retrospective analyses by Psaty et al. (JAMA 1995;274:620-625) have suggested that CCBs may be detrimental and may promote adverse cardiovascular events. I have recently reviewed the results of Psaty's meta-analysis and report (Arch Intern Med 1995;155: 2150-2156). I have emphasized that it is the rate of drug delivery into the systemic circulation that produces profound effects on the hemodynamic and neurohumoral responses to a dihydropyridine CCB drug. During chronic treatment with dihydropyridines, major fluctuations in blood pressure (rapid onset and offset of antihypertensive effects) during the dosing interval may persist for drugs and formulations that are short acting. In contrast, slow-release formulations of otherwise rapidly absorbed dihydropyridines achieve a more gradual and sustained antihypertensive effect. It is probable that newer CCB formulations that do not provoke intermittent sympathetic activation and do not evoke a cardioacceleratory response would not be expected to promote adverse cardiovascular events.

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Hypertension and Left Ventricular Hypertrophy: Is Drug Therapy Beneficial?

Cited by 8 publications

References 184 publications

A Comparison of the Effects of Mibefradil and Atenolol on Regression of Left Ventricular Hypertrophy in Hypertensive Patients

A Comparison of the Effects of Mibefradil and Atenolol on Regression of Left Ventricular Hypertrophy in Hypertensive Patients

Association of white blood cell counts with left ventricular mass index in hypertensive patients undergoing anti-hypertensive drug therapy

Calcium channel blockers and hypertension: Evolving perspectives?1996

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