Treating hypertension improves cardiac function in LV hypertrophy patients

NEW YORK (Reuters Health) – New data from the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, reported in a rapid release from the March 5th issue of Circulation: Journal of the American Heart Association, reveals that in hypertensive patients with left ventricular (LV) hypertrophy reducing BP improves diastolic filling.

In an interview with Reuters Health, lead author, Dr. Kristian Wachtell, from the Copenhagen County University Hospital, Glostrup, Denmark, said that "this is the first time it has been shown that any therapy can alter LV filling properties. In these patients, antihypertensive treatment improved the LV filling, which we saw in both active relaxation and in passive filling," he added.

Dr. Wachtell and associates collected data for 728 hypertensive patients with LV hypertrophy who participated in the LIFE study, which compared losartan with an atenolol-based treatment.

After 1 year of antihypertensive therapy, mean systolic BP dropped by 23 mm Hg and diastolic BP dropped by a mean of 11 mm Hg. Isovolumic relaxation time, E/A ratio and mitral valve deceleration time became more normal, and LV inflow deceleration time lengthened (p < 0.001), the researchers report.

These changes indicate an improvement in active LV relaxation and passive chamber stiffness during early diastole. LV filling became more normal and there was a decrease in pseudonormalization and abnormal relaxation with little change in restrictive filling patterns (p < 0.05), the LIFE team found.

Patients who had a reduction in LV mass also had lower left atrial diameter, shortened isovolumic relaxation time, an increase in E/A ratio and a prolonged LV inflow deceleration time (p < 0.001). However, there were no changes in diastolic filling among patients who did not have a reduction in LV mass or whose LV mass remained unchanged, Dr. Wachtell's group notes.

"Isovolumic relaxation time shortening was independently associated with reduction in LV mass. Increase in E/A ratio was independently associated with reduction in diastolic BP, and increase in the deceleration time was independently associated with reduced end-systolic relative wall thickness," the investigators found.

Based on these results, Dr. Wachtell concludes that "patients with LV hypertrophy, who have episodes of cardiac failure, need to have their BP lowered as much as possible because controlling BP may ameliorate their condition."

Dr. Wachtell added that whether other antihypertensive regimens would be as effective as the one used in the LIFE trial has not yet been determined.

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