Effects of nitrendipine on diastolic left ventricular function and hypertrophy in patients with hypertension

To assess the effects of antihypertensive therapy on the heart, left ventricular mass and performance indices (determined by M-mode and pulsed Doppler echocardiography) were compared before and after 4-5 months of nitrendipine therapy in 19 primary hypertensive patients (stage I and II). MAP was reduced from 17.1 +/- 1.7 to 14.5 +/- 1.7 kPa (128.5 +/- 12.7 to 109.0 +/- 13.1 mm Hg), P less than 0.001. The heart rate increased from 68 +/- 8 to 70 +/- 8 beats/min (P greater than 0.05). None of the indices for systolic function (SV, SI, CO, CI, EF, FS) changed significantly (P greater than 0.05). But the indices for diastolic function (RFF, RFR, VLef, IRP, EFv, A/E) improved remarkably (P less than 0.001 or 0.05). Furthermore, a positive correlation between the increasing rate of VLef and decreasing rate of MAP (r = 0.58, P less than 0.005) was noticed. Therefore, the decreasing in arterial pressure is considered as a major relative factor in the improvement of diastolic dysfunction. The patients were divided into two groups according to LVMI: group A, 11 patients with LVMI greater than or equal to 125 g/m2; while group B, 8 patients with LVMI less than 125 g/m2. The LV diastolic relaxation index IRP improved to a greater degree in group B (P less than 0.05), although the reduction of MAP was more markable in group A (P less than 0.05). This means that factors other than arterial pressure may influence the LV diastolic relaxation. In group A, the LVMI decreased from 155.1 +/- 29.9 to 144.4 +/- 33.0 g/m2 (a reduction of 7.0 +/- 9.0%). It suggests that LV hypertrophy can be "reversed" following nitrendipine therapy in some of the hypertensive patients.