TIME-COURSE OF COMPLETE NORMALIZATION OF LEFT-VENTRICULAR HYPERTROPHYDURING LONG-TERM ANTIHYPERTENSIVE THERAPY WITH ANGIOTENSIN-CONVERTINGENZYME-INHIBITORS

Metaanalyses have indicated that ACE inhibitors are more effective tha n other first-line therapies in reducing left ventricular hypertrophy (LVH). The average treatment period, however, was only approximately 6 months. The aim of the present study, therefore, was to clarify the t ime course and degree of reversal, and primarily to find out in how ma ny patients a complete normalization of LVH can be achieved. Secondly, we sought to determine whether atrial enlargement can be reduced. Pre viously untreated hypertensive patients (mean age 46.3 +/- 9 years, ei ght women, 15 men) with echocardiographically confirmed LVH (left vent ricular mass index ([LVMI] > 125 g/m(2) for men; > 110 g/m(2) for wome n) were prospectively treated over a 3-year treatment period with quin april. Nine patients received 10 mg quinapril, 12 received 20 mg of qu inapril daily, and five patients additionally received 25 mg hydrochlo rothiazide. The time course of changes in LVMI, relative wall thicknes s, left atrial size, fractional shortening, and diastolic function was evaluated and ambulatory blood pressure monitoring (ABPM) and an exer cise test were performed every 6 months. After a mean treatment period of only 7.5 months, there was a significant (P <.001), 17.5% decrease in LVMI with a further continuous and significant (P <.001) decrease of 38.6% after 38.3 +/- 3 months of therapy. In 90.5% of the patients a complete reversal of LVH was achieved. Fractional shortening increas ed significantly, the maximum being 14.6% after 38.3 a 3 months. The p eak early/atrial velocity (E/A) ratio increased significantly (P <.01) after just 7.5 +/- 3.1 months with no further changes during follow-u p. There seemed to be a parallel change with the decrease in left atri al dimension, where the most important decrease occurred after only 7. 5 a 3.1 months (P <.01), with a further continuous reduction. Our stud y clearly shows that maximum reversal of LVH is a time-consuming proce ss and that an essential goal of antihypertensive therapy should be no t only a reduction in LVH but also a normalization in LV mass, left at rial size, and in diastolic dysfunction. (C) 1998 American Journal of Hypertension, Ltd.