Evaluation of left ventricular mass and diastolic function in the treatment of hypertension with beta blockers [abstract]

ABSTRACT

Arterial hypertension is associated with left ventricular hypertrophy (LVH), and LVH increases the risk for cardiovascular morbidity and mortality. Selected antihypertensive agents have been shown to reverse LVH. In this study, the effects of celiprolol, a selective á1 blocker with partial agonist activity on á2 receptors and propranolol, a non-selective á-blocker, on blood pressure, left ventricular mass of diastolic function were compared. In a prospective study, twenty-nine patients with mild to moderate hypertension were randomly allocated to treatment with either celiprolol or propranolol for twelve weeks, after a three-week drug washout period. Cross-sectional doppler echocardiography was performed for the measurement of left ventricular mass and pulse doppler studies done for evaluation of left ventricular diastolic function. At the end of the study, both celiprolol and propranolol significantly reduced the diastolic blood pressure, while only celiprolol significantly reduced the systolic blood pressure. In the celiprolol group, there was a greater decrease in the left ventricular mass (7.9 percent) compared to the propranolol group (0.3 percent), but this was not significant. Doppler studies established that propranolol caused no significant change in the E/A ratio, while celiprolol caused a significant increase in the E/A ratio (p= 0.01). Propranolol increased the deceleration time (DT) (p= 0.001), while celiprolol decreased the isovolumetric relaxation time (IVRT) (p= 0.002) and increased the pulmonary venous A wave width (P= 0.02). In conclusion, short-term treatment with celiprolol demonstrated a trend towards decreasing the left ventricular mass, and caused significant improvement in left ventricular diastolic function, while propranolol did not. This may be due to the observation that celiprolol reduces total peripheral resistance by vasodilation. Treatment with celiprolol over a longer interval may result in significant reduction of left ventricular mass. (AU)