Left ventricular systolic function after marked reduction of ventricular hypertrophy induced by 5 years' enalapril treatment.
OBJECTIVE
To determine the effects of long-term treatment of essential hypertension with an angiotensin-converting enzyme inhibitor as regards arterial pressure at rest and during exercise, left ventricular mass and functional sequelae.


METHODS
Twenty-six patients with previously untreated essential hypertension took enalapril 20 mg twice daily for 5 years. Cardiovascular parameters were determined by two-dimensionally guided M-mode echocardiography in a pre-treatment placebo phase, 8 weeks and 1, 3 and 5 years after the start of therapy, and 8 weeks after drugs were discontinued.


RESULTS
Therapy reduced resting arterial pressure from 156/105 to 128/84 mmHg (P < 0.001) and arterial pressure during exercise from 205/113 to 172/94 mmHg (P < 0.0011). After 1, 3 and 5 years' therapy, left ventricular mass index had decreased by 15, 28 and 39% respectively (P < 0.001 in each case). Eight weeks after treatment was halted, arterial pressure at rest and during exercise had returned to pre-treatment values, but decreased left ventricular mass was maintained. Left ventricular pump function had improved after 5 years' treatment, and this improvement was maintained during the 8 weeks without treatment.


CONCLUSIONS
Significant reductions in arterial pressure at rest and during exercise were achieved by 8 weeks' treatment with enalapril and maintained during 5 years' further treatment, while a marked reduction in left ventricular mass took place progressively throughout the 5 year period. Reduction of myocardial hypertrophy by enalapril appeared to be beneficial rather than detrimental to cardiac pump performance.
González-Juanatey
J R
JR
Cardiology Department, Hospital General de Galicia, Clinico Universitario, Santiago de Compostela, Spain.
Pose Reino
A
A
García Acuña
J M
JM
Castelo Fuentes
V
V
Amaro Gendón
A
A
Calvo Gómez
C
C
Gil de la Peña
M
M
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004452:Echocardiography / Q000187:drug effects; D004656:Enalapril / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril