Alteration of left ventricular diastolic filling in hypertensive patients: Effects of nitrendipine and atenolol

This study was undertaken to determine the chronic effects ofa long-acting calcium-channel blocker (nitrendipine) on restingleft ventricular filling abnormalities in ten patients withessential hypertension. Radionuclide left ventricular curvesof these hypertensive patients were compared with the curvesof twelve normal volunteers and of eight asymptomatic olderpatients. The curves were analyzed for ejection fraction, peakfilling rate (normalized for end-diastolic counts and for strokecounts), time to peak filling rate and filling fraction in thefirst-third of diastole normalized for cycle length. Heart rateand ejection fraction were similar in both control groups andhypertensive patients before and after nitrendipine. Beforenitrendipine, Before nitrendipine, diastolic filling parameterswere significantly different in the hypertensive patients ascompared with the volunteers and with the volunteers and withthe asymptomatic aged patients: peak filling rate was lower,time to peak filling rate was longer and the first-third fillingfraction was smaller. After six weeks of nitrendipine therapy,systolic and diastolic blood pressure decreased significantly.After nitrendipine, the time to peak filling rate decreasedand the first-third filling fraction and the peak filling rate(normalized for stroke counts) increased significantly. Theacute oral administration of 100 mg atenolol induced a furtherdecrease in systolic blood pressure and a significant decreasein heart rate. The effect of combining nitrendipine and atenololon diastolic indexes was a preserved effect on time to peakfilling rate and on the first-third filling fraction. Theseresults suggest that short-term therapy with nitrendipine improvesearly diastolic dysfunction in hypertensives; the addition ofa beta-blocking agent further improved the early diastolic indexes.