Comparison of Spirapril, Isradipine, or Combination in Hypertensive Patients With Left Ventricular Hypertrophy Effects on LVH Regression and Arrhythmogenic Propensity

Abstract

This study was designed to evaluate in 45 hypertensive patients with left ventricular hypertrophy (LVH) the effects of a 6-month course with one of three different antihypertensive regimens (the calcium channel blocker isradipine, the angiotensin converting enzyme inhibitor spirapril in monotherapy, or a combination of the two drugs, n = 15 per group) on blood pressure, LVH regression, and various functional correlates of LVH. All three treatment modalities decreased significantly LV mass index by an average of 10%, although the combination had the greatest blood pressure-lowering effect and spirapril had the least, as assessed by office resting pressures, ambulatory monitoring, and isometric grip testing. There was no correlation between magnitude of blood pressure lowering and degree of LVH regression. The effects of treatment on pressor hormone profiles differed among groups, as spirapril tended to suppress angiotensin II and norepinephrine, whereas isradipine had opposite effects. Exercise tolerance was prolonged by all three regimens, but significantly more by the combination. All three regimens decreased significantly the double product by 10% to 15%. Indices of electrophysiologic stability calculated from analysis of ambulatory electrocardiogram exhibited significant improvement in several parameters such as QRS duration, presence of late potentials, and measures of heart rate variability, resulting in fewer episodes of simple or complex ventricular arrhythmia. We conclude that all three regimens produce significant LVH regression associated with improved functional capacity and electrical stability. These results reflect the sum of the differential hemodynamic and hormonal effects exerted by each treatment modality.

Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications

“…Existing evidence demonstrates that optimal blood pressure control and regression of LVH with antihypertensive therapy are associated with improved LV diastolic function, reduced LA size and changes in plasma catecholamines that may contribute to the prevention of cardiac arrhythmias. [62][63][64] Among different classes of antihypertensive agents, angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) appear to have better efficacy in terms of reduction of cardiac arrhythmias. 65 Blockade of RAAS has been proven to regress LVH and likely explains, in part, its protective effect in arrhythmias.…”

Prevalence of Paroxysmal Atrial Fibrillation Depending on the Regression of Left Ventricular Hypertrophy in Arterial Hypertension

“…This therapy also lowers the risk of cardiovascular complications (35) and results in fewer episodes of simple or complex arrhythmias (36). Recent reports have demonstrated that an antihypertensive therapy with regression of left ventricular hypertrophy results in a decrease of atrial diameter.…”

“…However, it should also be noted that not only the regression of left ventricular muscle mass, but also the effects of the blood pressure itself cause a reduction in paroxysmal atrial fibrillation. Antihypertensive therapy should lead to a better control of arterial hypertension (35) and consecutively to a regression of left ventricular hypertrophy (36) as well as an improved coronary flow reserve (14). These effects in turn cause an improvement of (8) and a decrease of left atrial dimension (15).…”

Reversible Left Ventricular Trabeculations in Pregnancy

“…In pressure overload of the left ventricle, we know that effective treatment of hypertension or critical aortic stenosis is associated with a change in left ventricular morphology and a decrease in left ventricular mass. 10,11 The degree of regression of left ventricular mass is not uniform in these populations. It is possible that there is variability in the regression of trabeculations in pregnancy similar to the variation in the reduction of left ventricular mass in effectively treated pressure-overload states.…”