THE EFFECTS OF LONG-TERM TREATMENT ON LEFT-VENTRICULAR HYPERTROPHY INPATIENTS WITH ESSENTIAL-HYPERTENSION - RELATION TO CHANGES IN NEUROHUMORAL FACTORS

This study compared the effects of 1 year of monotherapy with a calciu m-channel antagonist (nilvadipine; NIL), an angiotensin-converting enz yme (ACE) inhibitor (temocapril; TEM), or a new vasodilator (cadralazi ne; CAD) on left ventricular (LV) hypertrophy in essential hypertensio n. Furthermore, to elucidate the mechanism responsible for regression of LV hypertrophy after treatment, LV mass index (LVMI) by echocardiog raphy, plasma renin activity (PRA), aldosterone (PAC), norepinephrine, and atrial natriuretic peptide (ANP) concentration were measured befo re and after treatment. Thirty-six patients were randomly assigned to the NIL, TEM, or CAD groups. Blood pressure (BP) before treatment was 174 +/- 10/104 +/- 7, 173 +/- 18/103 +/- 8, and 171 +/- 16/103 +/- 7 m m Hg (mean +/- SD) in NIL, TEM, and CAD groups, respectively. BP was l ower after treatment with each of the three test drugs than after the placebo period, and there were no differences in BP reduction among th ree groups. LVMI, in NIL and TEM, was reduced from 129 +/- 48 to 115 /- 39 g/m(2) and from 117 +/- 39 to 88 +/- 20 g/m(2) (p < 0.05 and p < 0.01, respectively), whereas, in the CAD group, it was increased (110 +/- 30 to 138 +/- 27 g/m(2); p < 0.01). In the CAD group, PAC decreas ed and ANP increased significantly The change in LVMI correlated with that in BP for TEM and with that in ANP in all patients. These data in dicated that LV volume overload as well as LV pressure overload may co ntribute to LV hypertrophy and that monotherapy with CAD is not desira ble from the point of view of LV mass reduction in essential hypertens ion.