title: Cardiac structural and functional changes during long-term antihypertensive treatment with lacidipine and atenolol in the European Lacidipine Study on Atherosclerosis (ELSA).
abstract: OBJECTIVE
  To evaluate and correlate the effects of long-term antihypertensive treatment on left ventricular (LV) mass and carotid structural changes in a large group of essential hypertensive patients, participating in the European Lacidipine Study on Atherosclerosis (ELSA).
  
  
  METHODS
  In four (Brescia, Glasgow, Naples and Pisa) of 23 centres participating in the ELSA study, an echocardiographic examination was performed at baseline and repeated, until the end of the 4-year study, in essential hypertensive patients, followed-up for carotid quantitative ultrasound examination of intima-media thickness (IMT), after random allocation to treatment with either lacidipine or atenolol (and added hydrochlorothiazide, as required for control of blood pressure).
  
  
  METHODS
  M-mode, two-dimensional guided echocardiography was used to measure left ventricular (LV) wall thickness and dimensions, from which LV mass was calculated, using an anatomically validated formula (Penn Convention) and indexed to body surface area (left ventricular mass index, LVMI). The echocardiographic tracings were blindly evaluated in a single reading centre (Brescia). Bilateral IMT was measured at the site of common carotid and bifurcation far walls (CBMmax).
  
  
  RESULTS
  At baseline, cardiac and carotid ultrasound scans were available in 278 patients (mean age 54 +/- 7 years, 57% males, 22% obese). A significant correlation was observed between baseline LVMI and CBMmax (r = 0.22, P < 0.001), independent of age. In multivariate analysis, CBMmax and mean 24-h pulse pressure were most strongly associated with baseline LVMI. A significant reduction in LVMI was observed both during lacidipine (n = 96) (-12.5% reduction) and atenolol (n = 78) (-13.9% reduction) treatments (up to 4 years) (P < 0.001 for both, without significant differences between treatments). Changes in LVMI were not related to changes in carotid wall thickness. In multivariate analysis, baseline LV mass and mean 24-h systolic blood pressure changes were significantly associated with changes in LV mass.
  
  
  CONCLUSIONS
  In this large, long-term controlled study, antihypertensive treatment with atenolol or lacidipine was accompanied by a similar and significant decrease in LV mass. Treatment-induced changes in LV mass were related to baseline LV mass and changes in 24-h mean systolic blood pressure, without any correlation with changes in carotid structure. In the whole ELSA population, carotid IMT changes have been shown to be unrelated to blood pressure reduction, but significantly influenced by the type of antihypertensive treatment.
authors.affiliation: University of Brescia, Italy. agabiti@med.unibs.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Agabiti-Rosei
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Maria Lorenza
authors.initials: ML
authors.lastname: Muiesan
authors.forename: John
authors.initials: J
authors.lastname: Reid
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvetti
authors.forename: Rong
authors.initials: R
authors.lastname: Tang
authors.forename: Michael
authors.initials: M
authors.lastname: Hennig
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Baurecht
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanchetti
mesh_terms: D000328:Adult; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use*; D004095:Dihydropyridines / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013599:Systole / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D004095:Dihydropyridines; C060285:lacidipine; D001262:Atenolol