title: Effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency.
abstract: OBJECTIVE
  To investigate the effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency in early-stage hypertension.
  
  
  RESULTS
  We studied 527 participants from two clinical trials assessing the effect of blood pressure lowering on diastolic function. Participants were aged ≥45 years with early-stage hypertension, no heart failure, ejection fraction (EF) ≥50%, and diastolic dysfunction using Doppler echocardiography. Effective arterial afterload and its components were assessed along with measures of left ventricular (LV) structure and function prior to and after 24-38 weeks of antihypertensive therapy. Systolic blood pressure decreased from 154 ± 18 to 137 ± 15 mmHg at follow-up. Blood pressure reduction was associated with decreases in ventricular and arterial stiffness, improvements in systemic arterial compliance and resistance, enhanced LV ejection, and reduction in cardiac work (all P < 0.001). Changes in Ea/Ees ratio were inversely correlated with those in EF (r = -0.25; P < 0.001), stroke work index (r = -0.13; P = 0.007), and LV efficiency (r = -0.98; P < 0.001); and directly related to changes in mitral E/e' (r = 0.12; P = 0.01). Adjusting for age and blood pressure change, women and obese individuals had less enhancement in ventricular-arterial coupling and efficiency compared with men and non-obese individuals (P = 0.04 and 0.007, respectively).
  
  
  CONCLUSIONS
  Antihypertensive therapy reduces arterial and ventricular stiffness, enhances ventricular-arterial coupling, reduces cardiac work, and improves LV efficiency, systolic, and diastolic function. Attenuated responses in women and among obese subjects suggest that structure-function changes may be less reversible in these groups, possibly explaining their greater susceptibility to ultimately develop heart failure.
authors.affiliation: National University Health System, Tower Block Level 9, 1E Kent Ridge Road, Singapore 119228, Singapore. carolyn_lam@nuhs.edu.sg
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Anil
authors.initials: A
authors.lastname: Verma
authors.forename: Joseph
authors.initials: J
authors.lastname: Izzo
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001158:Arteries / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D013318:Stroke Volume / Q000187:drug effects; D059289:Vascular Stiffness / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents