Comparison of ketanserin and celiprolol on regression of left ventricular hypertrophy in older hypertensive patients

Abstract

The effects of ketanserin, a specific serotonin2-receptor agonist, and celiprolol, a new, highly cardioselective beta 1 blocker with partial beta 2 agonist activity and peripheral vasodilating properties, on left ventricular (LV) structure and function were assessed in 60 older hypertensive patients (greater than 55 years) with clinical LV hypertrophy (LV mass index greater than 130 g/m2). The patients were studied using echocardiography after 1 month of placebo treatment, and 6 and 18 months of monotherapy with active drug. Ketanserin and celiprolol lowered blood pressure to normal levels. Heart rate did not change with ketanserin and fell moderately (-5%) with celiprolol (p less than .001). Regression of LV hypertrophy was achieved with the use of either medication (p less than .0001), although the magnitude of reduction in LV mass was greater with celiprolol at both 6 months (-10% vs -5%, p = .001) and 18 months (-13% vs -7%, p = .002). While LV volume did not change with either drug, celiprolol tended to decrease it, resulting in a 5% reduction in cardiac index (p = .01), which was associated with mild bradycardia. Ketanserin did not change LV ejection fraction, whereas celiprolol caused a slight (1.5%) long-term improvement (p = .003). Systolic wall stress and total peripheral resistance decreased with both agents (p less than .01), with no between-group differences. In conclusion, anti-hypertensive treatment of older persons with ketanserin or celiprolol achieves regression of LV hypertrophy without associated deleterious effects on LV function.

Left Ventricular Hypertrophy

“…[1.3] Clinical trials have convincingly demonstrated the possibility of reducing LV mass, [34] and suggest that this may actually improve prognosis)17·95] Pharmacological regression of LVH has been demonstrated also in the aged,[21,52,86-88,11O] sometimes associated with effects which may benefit patients, such as suppression of ventricular arrhythmias [88] and improvement in contractile function. [86] Therefore, the option for treatment and prevention of LVH in the elderly seems justified based on available evidence. However, there is a lack of longitudinal studies on geriatric populations to assess the effects on major clinical events of LVH regression.…”

“…Several trials have demonstrated the possibility of reducing LV mass in young adult[34, 83,84] and elderly patientsPI,52, [85][86][87][88][89] To achieve this, it is necessary to treat the underlying conditions of LVH, particularly hypertension, ischaemic and valvular heart disease and obesity. Roman and colleagues [90] showed that aortic valve replacement normalised LV mass in two-thirds of patients with aortic stenosis.…”

A Risk-Benefit Assessment of Celiprolol in the Treatment of Cardiovascular Disease

“…In a study in 60 older hypertensive patients, significant regression ofLVH was achieved with long term celiprolol treatment (Vyssoulis et al 1992a). …”

Significance of blood pressure levels achieved with felodipine anti-hypertensive treatment on cardiovascular structure and function changes

“…9 Secondly, the structural changes of the cardiovascular system due to chronic hypertension are not always reversible with anti-hypertensive therapy, while they depend on the severity of the disease, as well as the type of pharmaceutical treatment applied. 10 Thirdly, as shown by extensive studies, the BP of hypertensive patients is not always satisfactorily reduced by treatment and it never reaches the BP levels of normotensive individuals in the same age group. It is well known that cardiovascular disorders are better related to the levels of BP under treatment, rather than its severity before the initiation of treatment, whereas in extensive studies it was established that the patients who most benefited were those with the lowest BP under treatment.…”