Left ventricular mass and filling pattern in patients with hypertension: doppler echocardiographic criteria for selection of antihypertensive agents

ABSTRACT

The objective of this study was to determine the value of Doppler echocardiographic derived left ventricular [LV] mass and filling patterns to guide selection of antihypertensive agent that favorably modulates the cardiac effects of hypertension. Thirty-six patients with mild to moderate hypertension were divided into three groups [12 patients each]. Patients who had reduced LV early filling pattern [early to late mitral flow velocity ratio <1] received nifedipine [group 1]. Patients who had increased LV mass index had received captopril [group 2]. Patients received atenolol were selected randomly [group 3]. All the three drugs showed significant decrease of systolic and diastolic blood pressure within six weeks of treatment. LV systolic function was preserved in all groups. Nifedipine was most effective to improve LV diastolic function by increasing early LV filling and shortening the isovolumic relaxation time. Captopril was most effective reducing LV mass, however, it was not associated with improving LV diastolic function. In conclusion, echocardiographic derived LV mass index and LV filling pattern successfully guided the use of captopril and nifedipine in hypertensive patients. LV mass regression and LV diastolic function improvement with antihypertensive therapy remains a surrogate endpoint. However, their influence on morbidity and mortality in patients with hypertension remains a required information