INFLUENCE OF ISRADIPINE AND SPIRAPRIL ON LEFT-VENTRICULAR HYPERTROPHYAND RESISTANCE ARTERIES

Left ventricular hypertrophy is a common clinical feature in hypertens ive patients and may be associated with structural changes in vessel m orphology. In an open prospective trial, we evaluated 14 patients with previously untreated hypertension (163 +/- 2/104 +/- 2 mm Hg) and an echocardiographically determined left ventricular mass index of 141.6 +/- 5.2 g/m(2), indicating left ventricular hypertrophy. We obtained a gluteal skin biopsy sample before starling treatment to investigate s ubcutaneous small-artery (approximately 200 to 400 mu m diameter) morp hology and function. Patients then received antihypertensive treatment with a combination of spirapril (3 or 6 mg) and isradipine (2.5 or 5 mg). Echocardiographic recordings were made after 6 months and 1 year, and a final biopsy was taken after 1 year. After 1 year, blood pressu re was significantly reduced to 142 +/- 3/90 +/- 1 mm Hg (P < .001), a nd left ventricular mass index decreased significantly to 105.3 +/- 5. 8 g/m(2) (P < .001). Baseline ms dia-lumen ratio (7.64 +/- 0.48%) was not markedly reduced (7.21 +/- 0.55%), although a decrease occurred in 7 of 12 evaluable patients. Norepinephrine induced vasoconstriction w as markedly reduced after 1 year. In conclusion, a significant regress ion of left ventricular hypertrophy was obtained after 1 year of treat ment with spirapril and isradipine, whereas a similar reduction in med ial dial thickness relative to lumen diameter of subcutaneous small ar teries could nor be observed in all patients. Reversal of structural c hanges in resistance vessels may require a longer treatment period in patients with proven left ventricular hypertrophy.