COMPARISON OF SPIRAPRIL, ISRADIPINE, OR COMBINATION IN HYPERTENSIVE PATIENTS WITH LEFT-VENTRICULAR HYPERTROPHY - EFFECTS ON LVH REGRESSION AND ARRHYTHMOGENIC PROPENSITY

This study was designed to evaluate in 45 hypertensive patients with l eft ventricular hypertrophy (LVH) the effects of a 6-month course with one of three different antihypertensive regimens (the calcium channel blocker isradipine, the angiotensin converting enzyme inhibitor spira pril in monotherapy, or a combination of the two drugs, n = 15 per gro up) on blood pressure, LVH regression, and various functional correlat es of LVH. All three treatment modalities decreased significantly LV m ass index by an average of 10%, although the combination had the great est blood pressure-lowering effect and spirapril had the least, as ass essed by office resting pressures, ambulatory monitoring; and isometri c grip testing. There was no correlation between magnitude of blood pr essure lowering and degree of LVH regression. The effects of treatment on presser hormone profiles differed among groups, as spirapril tende d to suppress angiotensin II and norepinephrine, whereas isradipine ha d opposite effects. Exercise tolerance was prolonged by all three regi mens, but significantly more by the combination. All three regimens de creased significantly the double product by 10% to 15%. Indices of ele ctrophysiologic stability calculated from analysis of ambulatory elect rocardiogram exhibited significant improvement in several parameters s uch as QRS duration, presence of late potentials, and measures of hear t rate variability, resulting in fewer episodes of simple or complex v entricular arrhythmia. We conclude that all three regimens produce sig nificant LVH regression associated with improved functional capacity a nd electrical stability. These results reflect the sum of the differen tial hemodynamic and hormonal effects exerted by each treatment modali ty. (C) 1998 American Journal of Hypertension, Ltd.