Time Course of Complete Normalization of Left Ventricular Hypertrophy During Long-Term Antihypertensive Therapy With Angiotensin Converting Enzyme Inhibitors

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.

Effects of Losartan Titrated to Losartan/Hydrochlorothiazide and Amlodipine on Left Ventricular Mass in Patients with Mild-to-Moderate Hypertension

“…Our results have to be interpreted with caution because of some limitations: (1) A longer lasting treatment beyond 16 weeks duration may have yielded a more pronounced reduction of LVM [7, 11, 24, 25]. (2) Our patient sample was small.…”

Ventricular Hypertrophy and Hypertension

“…Fouad et al [62] first demonstrated that treatment of hypertension could be accompanied by a reduction of echocardiographic LV mass. Reversing LVH has been shown to improve systolic and diastolic LV function, improve coronary flow reserve, and reduce the incidence of cardiac arrhythmia [63][64][65]. Subsequent studies have demonstrated that serial reductions in ECG indices of LVH have been associated with reductions in cardiovascular risk [66,67].…”

Relationship between Home Blood Pressure and Longitudinal Changes in Target Organ Damage in Treated Hypertensive Patients

“…It has been shown that ACE inhibitors are more powerful than other classes of drugs in terms of achieving LVH regression (28,29). It has also been shown that ACE inhibitors effectively reduce urinary albumin excretion in patients with diabetes nephropathy and other forms of renal disease (30,31).…”