REGRESSION OF LEFT-VENTRICULAR HYPERTROPHY IN ELDERLY HYPERTENSIVE PATIENTS TREATED WITH ANTIHYPERTENSIVE DRUGS

Background: Regression of left ventricular (LV) hypertrophy in patient s treated with antihypertensive drugs is not explained solely by the r eduction in blood pressure brought about by these drugs. In this study , we evaluated the role of the sympathetic nervous system and the reni n-angiotensin system in the regression of LV hypertrophy brought about by antihypertensive drugs. Methods: Thirty-seven elderly hypertensive patients were divided into groups based on their diastolic blood pres sure (DBP): the diastolic hypertension group (DHT, DBP greater-than-or -equal-to > 95 mm Hg) and isolated systolic hypertension group (ISH; D BP < 95 mm Hg). For 3 months, angiotensin-converting enzyme (ACE) inhi bitors were given to 14 patients with DHT and nine patients with ISH, and calcium antagonists were given to seven patients with DHT and seve n patients with ISH. Results: Both types of antihypertensive drugs dec reased blood pressure with a reduction of LV weight and without deteri oration of ejection fraction. In patients treated with calcium antagon ists, there was a significant positive correlation between the reducti ons of systolic blood pressure and LV weight (r = 0.90 in patients wit h DHT and r = 0.82 in patients with ISH). Reduction of LV mass by ACE inhibitors did not correlate with the changes in blood pressure, altho ugh there was a positive correlation between the basal plasma norepine phrine level and the change of LV mass in patients with DHT who were t reated with ACE inhibitors (r = 0.65). Conclusions: These results sugg est that in elderly hypertensive patients, calcium antagonists cause r egression of LV hypertrophy by the reduction of blood pressure. Mechan isms other than blood pressure reduction and sympathetic nervous syste m action may be involved in the decrease of LV weight in patients with DHT treated with ACE inhibitors.