DISPARATE EFFECTS OF ACE-INHIBITORS AND CALCIUM-ANTAGONISTS ON LEFT-VENTRICULAR STRUCTURE AND FUNCTION IN ESSENTIAL-HYPERTENSION

The present study was designed to compare the effects of angiotensin-c onverting enzyme (ACE) inhibitors and calcium antagonists - the two dr ug classes thought to be most effective in reducing left ventricular h ypertrophy - on arterial pressure, left ventricular structure and func tion in patients with essential hypertension. After a placebo period o f 4 weeks, a population of 96 patients were treated either with one of five different ACE inhibitors or one of six different calcium antagon ists, Cardiac structure and function was assessed by 2D-guided M-mode echocardiography. Whereas both drug classes lowered arterial pressure to the same extent, ACE inhibitors had a more pronounced effect on pos terior and septal wall thickness and left ventricular mass index than calcium antagonists, Diastolic function, as measured by peak filling r ate and duration of rapid filling, improved in both treatment groups t o the same extent, However, systolic performance, as assessed by midwa ll fractional fibre shortening, was significantly improved by ACE inhi bitors only, Myocardial contractility (end-systolic wall stress/end-sy stolic volume index) showed no significant change in the ACE inhibitor group but decreased after treatment with calcium antagonists. We conc lude that both calcium antagonists and ACE inhibitors lower arterial p ressure and increase left ventricular filling to the same extent. Howe ver, compared with calcium antagonists, ACE inhibitors had a more pron ounced effect on left ventricular mass and improved systolic ventricul ar performance in patients with essential hypertension.