Clinical trials of single-drug therapy for the cardiac effects of hypertension

Gottdiener, John S.

doi:10.1016/s0895-7061(98)00209-x

Cited by 6 publications

(6 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[170] Nonetheless, echocardiographic evaluation of the ejection phase indices of left ventricular function showed that antihypertensive treatment leading to LVM reduction is not associated with decreases in systolic function. This could be especially severe in sudden increases of blood pressure because the left ventricle is no longer protected against overload by compensatory hypertrophy.…”

Section: Effects On Systolic Functionmentioning

confidence: 98%

Effects of Antihypertensive Agents on the Left Ventricle

Dı́ez

González

López

et al. 2001

American Journal of Cardiovascular Drugs

View full text Add to dashboard Cite

Hypertensive heart disease (HHD) is characterized by left ventricular hypertrophy (LVH), alterations of cardiac function, and coronary flow abnormalities. LVH is an independent cardiovascular risk factor related to cardiovascular complications in patients with hypertension. Therefore, a decrease in left ventricular mass is a therapeutic goal in these patients. The effect of the different antihypertensive agents on LVH regression has been studied in nearly 500 clinical trials. Most studies conclude that there is regression of LVH after significant decrease in blood pressure with most commonly prescribed antihypertensive agents. However, the ability to regress LVH is different between antihypertensive drug classes. ACE inhibitors and calcium channel antagonists are more potent in reducing left ventricular mass than beta-blockers, with diuretics falling in the intermediate group. Recent data suggest that angiotensin AT(1) receptor antagonists reduce left ventricular mass to a similar extent as ACE inibitors or calcium channel antagonists. Although a large number of studies have established that reversal of LVH decreases the occurrence of adverse cardiovascular events in patients with hypertension, the hypothesis that LVH regression is beneficial has not yet been conclusively proven. On the other hand, the time has come to revisit the current management of HHD simply focused on controlling blood pressure and reducing left ventricular mass. In fact, it is necessary to develop new approaches aimed to repair myocardial structure and protect myocardial perfusion and function and, in doing so, to reduce in a more effective manner, adverse risk associated with HHD. The identification of genes involved in both the process of HHD and the response to therapy may be critical for the development of these new approaches. This article will review briefly the available data on the effects of antihypertensive agents on HHD. In addition, the emerging new concepts on the pharmacology of hypertensive myocardial remodeling and the pharmacogenetic basis of the treatment of HHD will be also considered.

show abstract

Section: Effects On Systolic Functionmentioning

confidence: 98%

Effects of Antihypertensive Agents on the Left Ventricle

Dı́ez

González

López

et al. 2001

American Journal of Cardiovascular Drugs

View full text Add to dashboard Cite

show abstract

“…Due to favorable effects, such as reduction of blood pressure, regression of ventricular hypertrophy, increase of the ischemic threshold, these drugs can be used in diastolic heart failure, especially in the presence of hypertension or coronary artery disease and atrial or ventricular arrhythmias. 13) Theoretically, it should be also beneficial in patients with exertional dyspnea by blunting heart rate response to exertion. However, their use in patients with advanced diastolic dysfunction (grade III or IV) must be done with great caution.…”

Section: Beta-blockersmentioning

confidence: 99%

Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective

2009

J Cardiovasc Ultrasound

View full text Add to dashboard Cite

I In nt tr ro od du uc ct ti io on nDespite the fact that up to 50% of heart failure patients have preserved left ventricular (LV) systolic function, treatment of diastolic heart failure remains largely empiric because there have been no large scale randomized trials evaluating the effects of specific pharmacological agents. Nonpharmacologic, pharmacologic and surgical approaches are available, although its efficacy has not been proven. Treatment should target the underlying pathological condition that causes the diastolic heart failure. For example, coronary artery disease, hypertensive heart disease, hypertrophic obstructive cardiomyopathy, and constrictive pericarditis provide relatively specific therapeutic targets, such as lowering of blood pressure, regression of hypertrophy and fibrosis, and treatment of ischemia, and a complete removal of constricting pericardium. Theoretically, pharmacological agents that facilitate myocardial relaxation and improve LV compliance would be ideal for the treatment of diastolic dysfunction. As a shortterm therapeutic goal, manipulation of the loading conditions (preload, afterload) and control of the heart rate will be crucial. The treatment of underlying condition (e.g. hypertension) should be the ultimate goal for the treatment of LV diastolic dysfunction. Many of the drugs used for the treatment of symptoms of heart failure due to diastolic dysfunction are similar to those of systolic dysfunction, although the rationale for their use, the pathophysiological process that is being altered by the drug, and the dosing regimen may be entirely different. In this review, several therapeutic modalities including pharmacologic, nonpharmacologic, and surgical approaches for primary diastolic heart failure will be discussed. P Ph ha ar rm ma ac co ol lo og gi ic c T Th he er ra ap py y Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockersACE-inhibitors and angiotensin II receptor blockers show not only an effect on blood pressure but elicit a direct effect on the myocardium via the local renin-angiotensin system. These effects are essential for the regression of LV hypertrophy, and the improvement in the elastic properties of the myocardium. 1)2) Several studies have documented that LV hypertrophy is more effectively reduced by ACE inhibitors than by other antihypertensive drugs, 3)4) suggesting an effect on myocardial structure beyond that provided by the reduction of pressure overload. Experimental and clinical studies suggest that the interaction of angiotensin II with its type 1 (AT1) receptors plays a critical role in alterations of collagen type I metabolism and development of myocardial fibrosis in arterial hypertension. Myocardial fibrosis is responsible for an increase in intrinsic myocardial stiffness that may alter the LV diastolic properties. Chronic activation of the reninangiotensin-aldosterone system has been shown to increase extracellular matrix fibrillar collagen and to be associated

show abstract

“…This class of medication is especially useful in treating patients with underlying coronary artery disease and those with atrial or ventricular arrhythmia [31]. …”

Section: Beta-blockersmentioning

confidence: 99%

Heart failure with normal ejection fraction

Ortiz

Freeman

2001

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Heart failure with normal ejection fraction, also known as diastolic heart failure, is a major problem for patients and health-care providers and is a substantial expense to society. The main pathophysiologic processes involved are increased left ventricular stiffness and abnormal relaxation, with resulting impaired left ventricular filling. These processes typically displace the pressure-volume relationship in an upward direction, resulting in increased left ventricular end-diastolic, left atrial, and pulmonary capillary wedge pressures, leading to symptoms of pulmonary congestion. The most common clinical disorders leading to diastolic heart failure are 1) hypertension with concentric left ventricular hypertrophy, 2) coronary artery disease with decreased left ventricular compliance, 3) hypertrophic cardiomyopathy, and 4) aortic stenosis with concentric left ventricular hypertrophy. Echocardiography and cardiac catheterization with magnetic resonance imaging hold promise as future diagnostic tools. The approach to the treatment of diastolic heart failure is focused on four treatment goals: 1) persistent control of elevated blood pressure, with regression of left ventricular hypertrophy, 2) careful reduction of central blood volume (diuretics), 3) maintenance of atrial contraction and control of heart rate (beta-blockers, digoxin, atrioventricular pacing); and 4) improvement of left ventricular relaxation. There is currently no drug treatment specific for abnormal relaxation, although efforts are being made to develop such compounds. A promising future therapy includes agents that lyse advanced glycation end-products as an approach to relieving increased ventricular stiffness. In addition to pharmacotherapy, maintaining ideal body weight and a regular exercise program are also helpful in the treatment of diastolic heart failure. Although the overall prognosis of patients with diastolic dysfunction is more favorable than that of patients with systolic dysfunction, the frequency of treatment failure and recurrent symptoms underscores the need for further improvement in treatment of this condition.

show abstract

Clinical trials of single-drug therapy for the cardiac effects of hypertension

Cited by 6 publications

References 59 publications

Effects of Antihypertensive Agents on the Left Ventricle

Effects of Antihypertensive Agents on the Left Ventricle

Therapeutic Strategies for Diastolic Dysfunction: A Clinical Perspective

Heart failure with normal ejection fraction

Contact Info

Product

Resources

About