DECREASE OF ANTIHYPERTENSIVE DOSAGE DURIN G LONG-TERM TREATMENT AND COMPLETE REGRESSION OF LEFT-VENTRICULAR HYPERTROPHY

Aim of study: To discover whether in hypertensives with left ventricul ar hypertrophy (LVH) the increased muscle mass will completely regress under antihypertensive treatment and drug dosage can in consequence b e reduced. Patients and method: Prospectively 22 previously untreated hypertensives (20 men, 2 women; mean age 43.6 +/- 9 years) with echoca rdiographically confirmed LVH were investigated. The observation perio d was 102 +/- 5 months. All patients initially received metoprolol, 10 0 mg daily, after 14 days 200 mg daily (additionally hydrochlorothiazi de in five patients). In all patients the blood pressure became normal at rest and on exercise within 6 weeks. Results: After one year the m ean left ventricular muscle mass index (LVMI) had fallen from 151 +/- 29 to 117 +/- 26 g/m(2) (P < 0.001), and after 7 years to 82 +/- 14 g/ m(2) (P < 0.001; -45.7%). Complete remission of LVH was demonstrated i n 21 Patients. The drug dosage could either be reduced or the drug com pletely discontinued in 11 patients (group 1): after 102 +/- 5 months four patients took no drug, while seven were on 100 mg metoprolol. Thi s was not possible in the other 11 patients (group 2), five of whom ha d been on both metoprolol and hydrochlorothiazide. The two groups diff ered with respect to loss of body weight (group 1: from 81.6 +/- 12 to 79.1 +/- 13 kg; P < 0.05; group 2: 85.7 +/- 8 to 88.1 +/- 10 kg; P < 0.05), but not regarding reduction of LVMI and blood pressure. Conclus ion: Antihypertensive treatment for several years leads to regression in LVH in nearly all patients. In half of them the drug dosage can be reduced or the drug even discontinued. Weight loss may play an importa nt part in this development.