title: Effect of nifedipine GITS on left ventricular mass and diastolic function in severe hypertension.
abstract: Treatment of severe hypertension is beneficial, but reversibility of target-organ damage has not been characterized. Serial studies were performed in 15 patients with severe essential hypertension (age of 56 +/- 3 years, mean +/- SEM) treated for 1 year with 60 to 150 mg/day of continuous-release nifedipine; 3 patients required 50 mg of chlorthalidone/day to lower diastolic blood pressure (BP) to less than 95 mm Hg. Left ventricular (LV) structure and function was evaluated with two-dimensional-directed M-mode echocardiography, digitized from videotape and analyzed blindly. BP was markedly reduced from 194 +/- 8/115 +/- 4 to 146 +/- 4/88 +/- 14 mm Hg (p less than 0.0001) and maintained at this level for 1 year. Posterior wall and septal LV thickness, elevated at entry (12.9 +/- 0.1 and 13.4 +/- 0.1 mm), dropped steadily over 1 year into the normal range (10.0 +/- 0.03 and 11.2 +/- 0.1 mm, p less than 0.001). LV mass index, above 95% for normals at entry, decreased by 19% at 6 months (129 +/- 10 to 104 +/- 7 g/m2, p less than 0.01), and remained at this level at 1 year. LV fractional shortening rose steadily over 1 year from 34 to 42% (p less than 0.02). Atrial natriuretic peptide, which reflects LV filling pressures, was markedly elevated at entry, but was significantly reduced by 6 months (76 +/- 22 vs. 45 +/- 14 pg/ml, p less than 0.05). Sustained reduction of arterial BP with continuous-release nifedipine for 1 year normalizes LV mass, improves LV systolic function, and reduces circulating levels of atrial natriuretic peptide.
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, New York, New York 10029.
authors.forename: R A
authors.initials: RA
authors.lastname: Phillips
authors.forename: M
authors.initials: M
authors.lastname: Ardeljan
authors.forename: S
authors.initials: S
authors.lastname: Shimabukuro
authors.forename: M E
authors.initials: ME
authors.lastname: Goldman
authors.forename: D L
authors.initials: DL
authors.lastname: Garbowit
authors.forename: H B
authors.initials: HB
authors.lastname: Eison
authors.forename: L R
authors.initials: LR
authors.lastname: Krakoff
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D003692:Delayed-Action Preparations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage / Q000627:therapeutic use*; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D003692:Delayed-Action Preparations; D009543:Nifedipine