Before angioplasty, abnormal coronary flow velocity dynamics are more marked distal than proximal to the stenosis. Greater increase in coronary flow velocities in the distal circulation after relief of endolumen obstruction results in a significant reduction in the proximal/distal flow velocity ratio. Thus, normalization of Doppler-derived flow velocity variables with marked reduction of the proximal/distal flow velocity ratios parallels angiographic success and may prove useful as an additional end point measurement in interventional cases with questionable angiographic findings.

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Context.-Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known. Objective.-To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH. Design.-Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP). Patients.-A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms. Intervention.-The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure. Main Outcome Measure.-Change in LV mass assessed by echocardiography. Results.-Minimum follow-up was 3 years. In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively. The LV mass index was 93 g/m 2 in the active treatment group and 100 g/m 2 in the placebo group (PϽ.001). The LV mass index declined by 13% (95% confidence interval, − 3% to − 23%) in the active treatment group compared with a 6% increase (95% confidence interval, − 3% to + 16%) in the placebo group over 3 years (P=.01). Conclusion.-Treatment of ISH with a diuretic-based regimen reduces LV mass.

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