EFFECT OF ANTIHYPERTENSIVE THERAPY ON LEFT-VENTRICULAR MASS AND DIASTOLIC FILLING IN MILD-TO-MODERATE HYPERTENSION

BACKGROUND: To valorate the effect of four antihypertensive drugs on t he regression of cardiac mass and diastolic function, by echocardiogra phy-Doppler, in not treated hypertensive subjects. METHODS: 60 mild-mo derate hypertensive subjects were studied randomized in four groups of 15 patients each one: enalapril (10-40 mg/d), atenolol (25-100 mg/d), verapamil-retard (120-240 mg/d), alphametildopa (250 mg/8h to 3 g/d). The active drug therapy phase was 6 months, performing echo-Doppler, evaluating posterior-wall and septal-wall thicknesses, ventricular mas s index, ratio of early to atrial peak diastolic filling velocity (E/A ), the first-third filling fraction and atrial filling fraction. RESUL TS: The cardiac mass index decreased with the four drugs: with enalapr il from 178 +/- 28 to 155 +/- 29 g/m2 (p < 0.05), with atenolol from 1 70 +/- 23 to 154 +/- 19 g/m2 (p < 0.05), with verapamil from 180 +/- 2 7 to 159 +/- 22 g/m2 (p < 0.05) and with alphametildopa from 176 +/- 3 0 to 142 +/- 22 g/m2 (p < 0.01). The E/A ratio and first-third filling fraction only improved in the atenolol subgroup, from 0.79 t 0.13 to 0.97 +/- 0.16 (p < 0.01) and from 36 +/- 5 to 44 +/- 9 % (p < 0.01), d ecreasing atrial filling fraction from 37 +/- 6 to 30 +/- 8 % (p < 0.0 1), without modifying with enalapril (0.74 +/- 0.14 to 0.76 +/- 0.20, 35 +/- 5 % to 36 +/- 7 %, 38 +/- 5 to 39 +/- 7 %, p = NS), verapamil ( 0.69 +/- 0.12 to 0.74 +/- 0.17, 35 +/- 6 % to 36 +/- 8 % to 40 +/- 12 %, p = NS) neither alphametildopa (0.72 +/- 0.14 to 0.71 +/- 0.21, 34 +/- 5 % to 35 +/- 7 40 +/- 6 % to 41 +/- 9 %, p = NS). The heart rate decreased more with atenolol than with the other drugs (61 +/- 15 vs 7 1 +/- 12, p : 0.01). CONCLUSIONS: In hypertensive patients the decreas ing of cardiac mass is not accompanied of improvement of the diastolic function except in patients treated with atenolol, probably due to br adycardia.