Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular Mass

Abstract

Abstract-Antihypertensive treatment can improve tissue Doppler indices of left ventricular diastolic function in the shortterm, but little is known about the longer-term effect of different antihypertensive treatments on progression of left ventricular diastolic function and left ventricular hypertrophy. We hypothesized that long-term treatment of hypertension will lead to improvements in left ventricular hypertrophy and diastolic function. We collected detailed cardiovascular phenotypic data on 1006 participants from a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial. Patients randomized to either an amlodipine±perindopril-based or an atenolol±bendroflumethiazide-based regimen underwent conventional and tissue Doppler echocardiography at time of control of blood pressure after randomization (≈1.5 years; phase 1) and after a further 2 years of antihypertensive treatment (phase 2). There were no prerandomization data. Five hundred thirty-six patients had complete data collection at both phases. Left ventricular mass index regressed from phase 1 to 2 with no significant difference between treatment groups (amlodipine: 119.5-116.8; atenolol: 122.9-117.5; P<0.001 for both). Conversely, tissue Doppler diastolic indices did not change in the amlodipine±perindopril-based regimen (E/e′, 7.5-7.6 cm/s; P=not significant), but deteriorated in the atenolol±bendroflumethiazide-based regimen (E/e′, 8.0-8.5 cm/s; P<0.01). Despite regression of left ventricular hypertrophy, there was no associated improvement in diastolic function. In fact, long-term treatment with atenolol±bendroflumethiazide resulted in a progressive deterioration in E/e′. This may be a factor contributing to the previously described worse clinical outcome in patients treated with atenolol± Methods PatientsThe population, methods, and response rate for the ASCOT study are described in detail elsewhere. 17 In brief, ASCOT was a randomized clinical trial of BP-lowering therapy in 19 257 men and women aged 40 to 79 years with hypertension. Hypertension was defined as either untreated (systolic BP ≥160 mm Hg and diastolic BP ≥100 mm Hg at screening and randomization) or inadequately treated hypertension (systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg at randomization). As well as hypertension the patients required ≥3 prespecified cardiovascular risk factors from previously identified LVH on echocardiography or electrocardiography, other specified electrocardiography abnormalities, type 2 diabetes mellitus, peripheral vascular disease, previous transient ischemic attacks or stroke, male sex, age ≥55 years, microalbuminuria/proteinuria, smoking, plasma total cholesterol/high-density lipoprotein ratio ≥6, and family history of ischemic heart disease in a first-degree relative (males aged <55 years, females aged <60 years). Patients with known ischemic heart disease or heart failure were excluded. The patients were then randomized to either atenolol±bendroflumethiazide-K (atenolol±bendroflumethiazide-based regimen) or amlodipine±perindopril (amlodipine±p...

Alterations in Cardiac Structure and Function in Hypertension

“…69, 81, 106, 107 Interestingly, the magnitude of reduction in LV mass was found to correlate only modestly with the extent of BP decline 81 . Muiesan et al 69 also observed an impact of antihypertensive treatment on LV geometry, with a normalization of LV geometry occurring in 9% of the 436 subjects and associated with a better prognosis.…”

“…However, two randomized clinical echocardiography sub-studies with larger sample sizes and longer duration of follow-up demonstrated no impact of antihypertensive therapy on diastolic function, despite adequate blood pressure control and significant regression of LV mass 81, 106 . This dissociation between structural and functional improvement may be related to the multifactorial pathogenesis of diastolic dysfunction.…”

Atrial Fibrillation and Hypertension

“…33 In a post hoc analysis of the ASCOT trial, a 1 mm Hg increase in SBP was associated with 2% higher baseline NT-proBNP (N-terminal pro-B-type natriuretic peptide), and this predicted adverse cardiovascular events with a 22% net reclassification improvement of cardiovascular risk. 34 Indeed, biomarkers, such as natriuretic peptides, allow identification of conditions related to LV volume overload, including those related to hypertension (eg, LV hypertrophy, diastolic dysfunction, and heart failure with preserved ejection fraction).…”

Порівняння Впливу Фіксованої Комбінації Периндоприл/Амлодипін На Ураження Органів-Мішеней У Пацієнтів З Артеріальною Гіпертензією З ішемічною Хворобою Серця Та Без Неї (Результати Дослідження EPHES)

“…Результати нашого дослідження щодо змін по-казника Е/Е' відрізняються від даних піддосліджен-ня дослідження ASCOT [8]. Показано, що на двох етапах спостереження на фоні терапії і амлодипіном (+ периндоприл), і атенололом (+ тіазид) відбува-лося майже однакове зменшення індексу ММЛШ (Р = НД).…”