Left ventricular function in mild hypertension after adrenergic blockade.

Abstract

We previously used the Doppler transmitral flow velocity ratio A/E (A = late ventricular filling peak velocity; E = early ventricular filling peak velocity) and the age-adjusted ratio A/E/Age to detect left ventricular filling abnormalities in untreated mild hypertension. This study is a double-blind assessment of the effect of combined a-and /3-blockade (labetalol) and ^-blockade alone (atenolol) on left ventricular filling in mild hypertension. Twenty-seven patients blindly randomized to labetalol (12 patients) and atenolol (15 patients) treatment completed the echocardiographic and Doppler studies. Clinical and echo-DoppIer data obtained at baseline and 6 weeks after initiation of therapy showed no difference between the two groups for age (49 ± 10 vs 46 ± 10 years), mean blood pressure (before therapy, 118 ± 9 vs 117 ± 8 mm Hg; after therapy, 108 ± 12 vs 108 ± 10 mm Hg), left ventricular dimensions, wall thickness, systolic function, and mean late filling velocity A. There was no significant change in left ventricular mass and mass index with labetalol (left ventricular mass, 211 ± 3 6 vs 216 ±38; mass index, 110 ±17 vs 112 ±16) or atenolol (245 ± 4 1 vs 271 ±65; 120 ± 18 vs 130 ± 35). The mean velocity E, A/E, and A/E/Age ratios significantly unproved with labetalol (p<0.05) but did not change significantly with atenolol. The improvement in A/E and PJEJkge ratios was primarily due to an increase in early filling velocity E. There was a significant correlation between improvement in velocity E and reduction in systolic blood pressure (r = 0.57, p< 0.05) and mean blood pressure with labetalol (r = 0.63, p < 0.05). In conclusion, short-term combined a-and /S-adrenergic blockade improves diastolic filling in mild hypertension. (Hypertension 11 [Suppl I]: I-98-I-102, 1988) KEYWORDS inhibition Doppler echocardiography • ventricular filling • a-and/3-adrenergic receptor

Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

“…However, in early, mild hypertension, LVH is usually absent and the first manifestation of hypertension is diastolic dysfunction. 58,62 This can be detected as grade 1 diastolic impairment, or impaired relaxation. Over time however, if left untreated, filling pressures continue to rise, ventricular hypertrophy develops as an adaptive response to chronic pressure, and more severe disturbances of diastolic filling are more commonly encountered.…”

Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)^{<xref ref-type="fn" rid="AN1">†</xref>}

“…hypertension is diastolic dysfunction 58,62. This can be detected as grade 1 diastolic impairment, or impaired relaxation.…”