Physical Performance is Preserved After Regression of Left Ventricular Hypertrophy

Abstract

Reversal of left ventricular hypertrophy has been shown to improve left ventricular diastolic function in elderly patients with hypertension, but little is known about whether this affects physical performance. Left ventricular mass, cardiac function at rest and during submaximal exercise, and physical performance were assessed in 38 elderly patients with hypertension with left ventricular hypertrophy and normal systolic function before and after 8 and 14 months of therapy with amlodipine or hydrochlorothiazide or both. Blood pressure control was achieved with amlodipine in 18 patients, with hydrochlorothiazide in seven, and with the combination of these drugs in 13. Left ventricular mass index was similarly reduced from approximately 150 to approximately 100 g/m2 at 14 months' in each treatment group. Systolic function was maintained with the three treatment regimens, whereas similar decreases in time to peak filling rate and increases in first-third filling fraction occurred both at rest and during submaximal exercise after 8 months and further after 14 months of therapy. Exercise capacity did not significantly change in the group as a whole, but individual changes in peak oxygen uptake at the end of treatment correlated significantly with the decrease in time to peak filling rate during submaximal exercise (r = -0.49; p < 0.01). It is concluded that long-term blood pressure control with amlodipine or hydrochlorothiazide or both is associated with significant reductions in left ventricular mass and improved diastolic function in elderly patients with hypertension with left ventricular hypertrophy. Despite this reduction in left ventricular mass, left ventricular systolic function and physical performance are well preserved during submaximal exercise.

Exercise performance during losartan‐ or atenolol‐based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

“…However, results of earlier studies in our laboratory might be less applicable in the present study population that was both considerably older and selected for presence of electrocardiographic LV hypertrophy. In fact, our finding that exercise capacity did not improve during antihypertensive treatment leading to reduction in LV mass is in accordance with results from several other studies, including a Canadian study by Lacourciere et al in elderly hypertensive patients receiving amlodipine or hydrochlorothiazide (12), and a study by Fagard & Lijnen in middle-aged hypertensive patients receiving either hydrochlorothiazide or converting enzyme inhibitor (27), while reduced exercise performance has been reported in young hypertensive patients both during short-term and long-term antihypertensive treatment with atenolol (14,28,29). Of note, population-based nomograms suggest the annular decrease in peak oxygen uptake to be 1.83% (30), which is very close to the actual change found during 1-year follow-up in the present study.…”

“…Previous studies have confirmed that sustained blood pressure reduction reduces LV hypertrophy and improves diastolic LV function, but only limited data are available on the influence of LV hypertrophy reduction on exercise capacity in hypertensive patients (11,12). Furthermore, the antihypertensive drug used to lower blood pressure may influence exercise capacity through its individual hemodynamic action.…”

Left Ventricular Hypertrophy in Hypertension

“…In one study of 38 elderly patients with hypertensive LVH, amlodipine, hydrochlorothiazide or both were administered to reduce blood pressure to normal levels [66]. Along with reduction of blood pressure and LV mass indices, physical performance was well preserved, as measured by exercise capacity.…”