TIME-COURSE OF REDUCTION IN LEFT-VENTRICULAR MASS DURING LONG-TERM ANTIHYPERTENSIVE THERAPY

Left ventricular mass sometimes decreases during treatment of hyperten sion but the effects are inconsistent and the response to long-term tr eatment is unknown. Therefore the long-term effects of antihypertensiv e therapy on echocardiographically-proven left ventricular hypertrophy (LVH) were prospectively investigated in 117 previously untreated hyp ertensive patients (mean age 46 +/- 9 years; 15 women and 102 men). Tw enty-two patients received 100 mg of gallopamil daily, 24 patients rec eived 200 mg of metoprolol, 35 patients received both 50 mg of atenolo l and 20 mg of nifedipine (follow-up five years), 14 patients received 200 mg of acebutol plus 20 mg of nifedipine, and 21 patients received 50 mg of atenolol and 10 mg of enalapril daily (follow-up of four yea rs). For the entire population, there was a significant (P < 0.001) de crease in left ventricular mass index (LVMI; measurements were perform ed blind by two observers) of 24.5% after one year, with a further con tinuous and significant (P<0.001) reduction of 44.1% after five years of treatment. There was a significant (r = 0.61, P < 0.001) correlatio n between the extent of LVMI before therapy and the percentage of regr ession of LVMI after five years of treatment. In 82% of the patients, almost complete regression of LVH was achieved. Nevertheless, there wa s no significant change in ventricular end-diastolic dimension but fra ctional shortening increased by 16% (P < 0.001). It can be concluded t hat achieving maximum regression of LVH by antihypertensive therapy in previously untreated hypertensives takes a long time and depends not only on the drug regimen chosen but especially on the duration of trea tment and the extent of pretreatment left ventricular mass.