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Abstract
Hypertension is a leading non-communicable disease and the most prevalent cardiovascular disease. Adaptation of the left ventricle to systemic hypertension is complex and it is characterized by functional and structural changes. Increased LV mass is a recognized complication of systemic hypertension and has been shown to be an important predictor of cardiovascular morbidity and mortality. The current study was undertaken to determine whether antihypertensive therapy reduce LVM, and whether these changes are accompanied by improved diastolic function. Methods: 60 patients (pts.) with mild hypertension were divided into two groups: Group (I) included 30 pts. who received ACE inhibitors; 15 pts. received Ramipril 5-10 mg once daily, and constituted subgroup Ia, and 15 pts. received Fosinopril 20 mg once daily, and constituted subgroup Ib. Group (II) included 30 pts.who received beta blockers (BB); 15 pts.received Atenolol 50-100 mg once daily, and constituted subgroup IIa, and 15 pts. received Metoprolol 100 mg once daily, and constituted subgroup IIb. Twenty healthy volunteers comprised a control group. To assess the effects of antihypertensive therapy on the heart; LVM, systolic and diastolic function, by M-mode, 2-D and pulsed wave Doppler echocardiography were evaluated. Echocardiographic examinations were performed before therapy, after 2 weeks from the start of therapy and at 2, 4 and 6 months intervals. Results: At baseline, there were 13 pts. with LVH in a ratio 21.6% of total hypertensive pts. while the rest of the hypertensive pts., 47 pts (78.4%), had normal geometric pattern. The concentric LVH was the predominant form (53.8%) followed by eccentric LVH (30.7%) and finally concentric remodeling (15.3%). Indeces of systolic function in studied pts. were normal while indeces of LV diastolic filling were significantly abnormal in pts. with hypertensive LVH compared to control. After therapy, normalization of blood pressure was achieved in all hypertensive patients. A significant reduction of LVM, RWT and improvement of LV diastolic filling was observed earlier with ACE inhibitors than with beta-blockers. Of particular interest was the fact that improvement in diastolic performance appeared earlier, and was preceded regression of LVM. Conclusion: 1-Therapy with ACEI and BB results in prevention/ regression of development of LVH in hypertensive patients. 2-The regression of LVM, LVMI, RWT and the improvement of LV diastolic function appears more evident and earlier with ACEI therapy than with BB therapy. 3-Improvement of LV diastolic function appears earlier, preceding the regression of LVH.