The Effects of Antihypertensive Therapy on Left Ventricular Mass in Elderly Patients

Abstract

Left ventricular mass sometimes decreases during treatment of hypertension, but this response is inconsistent and its effects on left ventricular function are unknown. In a six-month randomized trial, we studied the ability of verapamil and atenolol to reduce left ventricular mass in 42 elderly patients with hypertension and the effects of this reduction in mass on cardiac function. The mean blood pressure (±SE) decreased in both the group that received verapamil (from 171.4±3.2/93.0±2.5 mm Hg to 142.9±2.8/79.0±2.0 mm Hg) and the group that received atenolol (from 179.6±4.6/98.5±2.4 mm Hg to 148.1±3.3/83.4±1.2 mm Hg), but the atenolol-treated patients more frequently required the addition of chlorthalidone to achieve blood-pressure reduction (P < 0.01). Verapamil resulted in a reduction in the left-ventricular-mass index from 104±5 g per square meter of body-surface area to 85±5 g per square meter (P < 0.01). Atenolol did not produce a reduction in the left-ventricular-mass index (109±9 g per square meter before treatment vs. 112±10 g per square meter after treatment). Two weeks after the withdrawal of antihypertensive therapy, blood pressure returned to pretreatment values. Nevertheless, in patients whose left ventricular mass had decreased, two measures of diastolic filling, the peak diastolic filling rate of the left ventricle and the ratio of the peak filling rate to the peak ejection rate, were significantly higher than before treatment (2.42±0.2 vs. 3.31±0.4 [P < 0.05] and 0.61±0.03 to 0.85±0.05 [P < 0.05], respectively). Diastolic filling was unchanged in the group that had no reduction in left ventricular mass. Cardiac output and the ejection fraction at rest and during mild exercise were unchanged in both groups as compared with base-line values. We conclude that left ventricular mass can be reduced in elderly patients with hypertension and mild ventricular hypertrophy who receive antihypertensive therapy. Reduction occurs more frequently with verapamil than with atenolol therapy, increases diastolic filling, and does not impair systolic function. HYPERTENSION is the most prevalent and most strongly predictive remediable risk factor for cardiovascular disease in older persons. 1 Although the control of blood pressure is readily achieved and reduces the risk of cardiac death and stroke, 2,3 it is not clear whether reduction in the mass of the left ventricle should also be a therapeutic goal of antihypertensive therapy in this age group. 4,5 Although regression is theoretically desirable, 6,7 it is not known whether it is possible in the elderly or whether it would, in fact, improve or impair ventricular function. 5 This concern is emphasized by studies of an animal model of… © 1990, Massachusetts Medical Society. All rights reserved.