Effect of cilnidipine on left ventricular diastolic function in hypertensive patients as assessed by pulsed Doppler echocardiography and pulsed tissue Doppler imaging

The pur-pose of the present study was to examine the mechanisms of improvem ent in left ventricular (LV) diastolic function in hypertensive patients tr eated with cilnidipine, a new and unique calcium antagonist that has both L -type and N-type voltage-dependent calcium channel blocking actions, using pulsed Doppler echocardiography and pulsed tissue Doppler imaging. The stud y comprised 35 untreated patients with essential hypertension (19 men and 1 6 women; mean age 65 +/- 10 years). The peak early diastolic and atrial sys tolic transmitral flow velocities (E and A, respectively) and their ratio ( E/A), and the peak early diastolic and atrial systolic motion velocities (E w and Aw, respectively) of the]LV posterior wall and their ratio (Ew/Aw) we re determined in all patients before and after 1, 3 and 6 months on cilnidi pine (10mg/day). One month: Systolic and diastolic blood pressures were sig nificantly decreased. E and E/A were significantly increased, whereas there were no significant changes in Ew and Ew/Aw. Three months: Ew and Ew/Aw we re significantly increased compared to those before and 1 month after cilni dipine. Six months: E and E/A were significantly increased compared with be fore and 3 months after cilnidipine, and Ew and Ew/Aw were significantly in creased compared with before cilnidipine. Moreover, the LV mass index was s ignificantly decreased compared to that before cilnidipine. In summary, cha nges in LV diastolic performance in patients with essential hypertension fo llowing cilnidipine treatment were biphasic with an initial increase in ear ly diastolic transmitral flow velocity and a later increase in early diasto lic LV wall motion velocity. The initial and later changes can be related t o an acute change in afterload and a later improvement in LV relaxation.