CAPTOPRIL OR NITRENDIPINE IN THE TREATMENT OF HYPERTENSION - EFFECT ON LEFT-VENTRICULAR MASS AND DIASTOLIC FUNCTION

Changes in left ventricular (LV) mass and parameters of LV-diastolic function were studied noninvasively in 36 hypertensive patients (HY) before, during and after 20-22 weeks of antihypertensive therapy. 18 patients were treated with the converting enzyme inhibitor captopril (CA), 18 patients received the calcium-channel blocker nitrendipine (NI). In 9 patients an additive diuretic (HCT) was necessary to achieve adequate blood pressure control. Before therapy, HY were compared with 36 healthy, in age and sex matched persons. Beside differences in blood pressure, HY showed increased LV mass LVMMI (105 +/- 19 vs 135 +/- 26 g/m2; p < 0.001). In HY we found increased flow velocities (Vmax) and areas under the curve (TVI) during late diastole, measured by pulsed Doppler echocardiography: VmaxA (0.64 +/- 0.12 vs 0.57 +/- 0.12 m/s; p < 0.05), TVI-A (6.52 +/- 1.67 vs 5.47 +/- 1.20 cm; p < 0.05) and a flow velocity in the LV-outflow tract, VmaxA* (0.54 +/- 0.11 vs 0.46 +/- 0.12 m/s; p < 0.01) were increased, VmaxE/VmaxA was lowered (1.08 +/- 0.38 vs 1.26 +/- 0.37; p < 0.05) in HY. After 4 months of treatment, LVMMI had decreased in both groups (CA: 138 +/- 27 vs 123 +/- 25 g/m2; p < 0.01; NI: 130 +/- 24 vs 120 +/- 21 g/m2; p < 0.05). In the CA group, isovolumetric relaxation time (IVRT) had shortened (69 +/- 29 vs 54 +/- 16 ms; p < 0.05). CA therapy led to a significant increase in VmaxE/VmaxA (1.22 +/- 0.42 vs 1.12 +/- 0.35; p < 0.05), TVI-E (12.25 +/- 2.90 vs 11.46 +/- 2.76 cm; p < 0.05) and TVI during first third of diastole, TVI-D/3 (8.99 +/- 2.44 vs 8.10 +/- 2.35 cm; p < 0.05). In the NI group, we found reduced IVRT (62 +/- 24 vs 85 +/- 17 ms; p < 0.01) and an increase in VmaxE (0.71 +/- 0.13 vs 0.64 +/- 0.16 m/s; p < 0.05), VmaxE/VmaxA (1.15 +/- 0.53 vs 1.05 +/- 0.43; p < 0.05), TVI-E/TVI-A (1.91 +/- 0.93 vs 1.75 +/- 0.84; p < 0.05) and TVI-D/3 (8.91 +/- 2.16 vs 7.92 +/- 2.38 cm; p < 0.05). We found no differences between CA and NI group after 4 months of treatment. In both groups, there was no correlation between blood pressure reduction, decreased LV mass and changes in diastolic function. Antihypertensive treatment with CA and NI leads to LV-mass reduction and slight improvement of diastolic function. We could not find a correlation between normalization of morphology and the improvement of functional parameters. The presence of further determinants of diastolic dysfunction (e.g. LV fibrosis) still has to be assumed.