Successful treatment of hypertension accounts for improvements in markers of diastolic function - a pilot study comparing hydrochlorothiazide-based and amlodipine-based treatment strategies.
BACKGROUND
There is controversy regarding whether blood pressure (BP) medications have relevant therapeutic benefits beyond those due to lowering of BP.


OBJECTIVE
To show that rapid successful treatment of hypertension leads to improvement in cardiac morphology and function regardless of the pharmacological agents used.


METHODS
Hypertension was defined as an average 24 h ambulatory BP of higher than 135/85 mmHg in 38 subjects with a mean (+/- SD) age of 54+/-7 years. Patients were randomly assigned to treatment with a diuretic based (n=20) or a calcium channel blocker (CCB)-based (n=18) medication. All subjects were followed every two weeks, and similar additional medications were added until the BP was lower than 125/80 mmHg, then followed monthly for a total of six months. Echocardiography with tissue Doppler imaging was performed, and was repeated after six months of aggressive pharmacotherapy and lifestyle management.


RESULTS
Baseline ambulatory BP monitoring and echocardiographic measures of diastolic function were similar between both treatment groups. Subjects received 3.5+/-1 pills and 11+/-2 follow-up visits. The average 24 h BP was reduced from 145/91 mmHg to 124/75 mmHg (P<0.001) in the CCB group. A greater lowering from 143/91 mmHg to 117/72 mmHg occurred in the diuretic group (P=0.02 for the difference between groups) at six months. There was significant improvement in tissue Doppler imaging diastolic function parameters in both groups, with a trend toward greater improvement in the diuretic group. The left ventricular mass/ height(2.7) index decreased from 40 g/m(2.7) to 37 g/m(2.7) in the diuretic group (P=0.02), whereas a nonsignificant change (41 g/m(2.7) to 42 g/m(2.7)) occurred in the CCB group.


CONCLUSIONS
Aggressive BP lowering is associated with improved left ventricular diastolic function and mass proportional to the extent of BP normalization.
Ogunyankin
Kofo O
KO
Department of Medicine and Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60611, USA. k-oguyankin@northwestern.edu
Day
Andrew G
AG
D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D017311:Amlodipine