Angiotensin Converting Enzyme Inhibition with Quinapril and Left Ventricular Mass in the Hypertensive Patient

Abstract

The effects of quinapril (an angiotensin converting enzyme inhibitor) on cardiac hypertrophy were evaluated in a noncomparative study of 98 patients with mild to moderate hypertension over 4 months. Left ventricular hypertrophy (LVH) was diagnosed using echocardiography in 60% of patients at baseline. Combination therapy with hydrochlorothiazide (HCTZ) was initiated after I month in patients with inadequate blood pressure control to achieve a target diastolic pressure reduction from baseline (~ 10mm Hg) and/or reduction to < 90mm Hg. Left ventricular mass index (LVMI) was significantly reduced for patients of either sex with a baseline diagnosis of LVH, but not for those in whom LVH was not detected at enrolment. Systolic and diastolic blood pressures were also significantly reduced. The response rate was 83%, while 28% of patients required combination therapy with HCTZ. There was no correlation between the hypotensive effects of quinapril and change in LVMI. Furthermore, the addition of a diuretic did not appear to affect the LVMI response. Thus, the amelioration of LVH noted in this investigation appears to be attributable to quinapril.Electrocardiographically detected left ventricular hypertrophy (LVH) has been recognised as an independent risk factor for increased cardiovascular morbidity and mortality for many years. [1,2] However, diagnostic ECG signs of LVH are relatively infrequent among patients with hypertension; their prevalence ranged from 3 to 5% in adults recruited to the Framingham study[l] and the Hypertension Detection and Follow-up Program. [3] The introduction of the echocardiographic technique as a much more sensitive and accurate method for LVH detection [4,5] has significantly increased the estimated prevalence of LVH, which is currently thought to range between 25 and 30% in