LEFT-VENTRICULAR SYSTOLIC FUNCTION AFTER MARKED REDUCTION OF VENTRICULAR HYPERTROPHY INDUCED BY 5 YEARS ENALAPRIL TREATMENT

Objectives: To determine the effects of long-term treatment of essenti al hypertension with an angiotensin-converting enzyme inhibitor as reg ards arterial pressure at rest and during exercise, left ventricular m ass and functional sequelae. Patients and Methods: Twenty-six patients with previously untreated essential hypertension took enalapril 20 mg twice daily for 5 years. Cardiovascular parameters were determined by two-dimensionally guided M-mode echocardiography in a pre-treatment p lacebo phase, 8 weeks and 1, 3 and 5 years after the start of therapy, and 8 weeks after drugs were discontinued. Results: Therapy reduced r esting arterial pressure from 156/105 to 128/84 mmHg (P<0.001) and art erial pressure during exercise from 205/113 to 172/94 mmHg (P<0.0011). After 1, 3 and 5 years' therapy, left ventricular mass index had decr eased by 15, 28 and 39% respectively (P<0.001 in each case). Eight wee ks after treatment was halted, arterial pressure at rest and during ex ercise had returned to pre-treatment values, but decreased left ventri cular mass was maintained. Left ventricular pump function had improved after 5 years' treatment, and this improvement was maintained during the 8 weeks without treatment. Conclusions: Significant reductions in arterial pressure at rest and during exercise were achieved by 8 weeks ' treatment with enalapril and maintained during 5 years' further trea tment, while a marked reduction in left ventricular mass took place pr ogressively throughout the 5 year period. Reduction of myocardial hype rtrophy by enalapril appeared to be beneficial rather than detrimental to cardiac pump performance.