Assessment of arterial ventricular coupling changes in patients under therapy with various antihypertensive agents by a non-invasive echocardiographic method.
BACKGROUND
The integration between arterial and ventricular function has been studied by mostly invasive techniques. We considered assessing the influence of various antihypertensive medications on arterial-ventricular coupling (AVC) with the use of a non-invasive echocardiographic method.


METHODS
A total of 9037 patients, who had been under treatment for essential arterial hypertension were studied echocardiographically at baseline prior to therapy and after 6 months of antihypertensive monotherapy (diuretics, beta-blockers without intrinsic sympathomimetic activity (ISA), beta-blockers with ISA, a-blockers, angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (AIIRA), non-dihydropyridine calcium antagonists, and dihydropyridine calcium antagonists). The AVC was calculated by echocardiographic measurements based on the equation: AVC=ESV/SV (ESV, end systolic volume; SV, stroke volume).


RESULTS
ACEI, AIIRA, and dihydropyridine calcium antagonists decreased (P<0.0001 for all) while diuretics, alpha-blockers, both beta-blocker groups, and non-dihydropyridines increased significantly the AVC values compared to baseline measurements (P<0.0001 for all, except P=0.02 for alpha-blockers). Changes in AVC were the most highly correlated with changes in EF (r=-0.979, P<0.0001).


CONCLUSIONS
Various antihypertensive drugs have a differential effect on AVC with ACEI, AIIRA, and dihydropyridine calcium antagonists having the most favorable effect on this index. AVC provides a meaningful index of cardiovascular performance in hypertension and offers the possibility of wide employment and serial follow-up in large numbers of patients because of its completely non-invasive nature.
Iakovou
Ioannis
I
1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. iako@hol.gr
Karpanou
Evaggelia A
EA
Vyssoulis
Gregory P
GP
Toutouzas
Pavlos K
PK
Cokkinos
Dennis V
DV
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D004548:Elasticity / Q000187:drug effects*; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects; D014463:Ultrasonography
D000959:Antihypertensive Agents