Long-term antihypertensive treatment fails to improve E/e' despite regression of left ventricular mass: an Anglo-Scandinavian cardiac outcomes trial substudy.
Antihypertensive treatment can improve tissue Doppler indices of left ventricular diastolic function in the short term, but little is known about the longer-term effect of different antihypertensive treatments on progression of left ventricular diastolic function and left ventricular hypertrophy. We hypothesized that long-term treatment of hypertension will lead to improvements in left ventricular hypertrophy and diastolic function. We collected detailed cardiovascular phenotypic data on 1006 participants from a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial. Patients randomized to either an amlodipine±perindopril-based or an atenolol±bendroflumethiazide-based regimen underwent conventional and tissue Doppler echocardiography at time of control of blood pressure after randomization (≈1.5 years; phase 1) and after a further 2 years of antihypertensive treatment (phase 2). There were no prerandomization data. Five hundred thirty-six patients had complete data collection at both phases. Left ventricular mass index regressed from phase 1 to 2 with no significant difference between treatment groups (amlodipine: 119.5-116.8; atenolol: 122.9-117.5; P<0.001 for both). Conversely, tissue Doppler diastolic indices did not change in the amlodipine±perindopril-based regimen (E/e', 7.5-7.6 cm/s; P=not significant), but deteriorated in the atenolol±bendroflumethiazide-based regimen (E/e', 8.0-8.5 cm/s; P<0.01). Despite regression of left ventricular hypertrophy, there was no associated improvement in diastolic function. In fact, long-term treatment with atenolol±bendroflumethiazide resulted in a progressive deterioration in E/e'. This may be a factor contributing to the previously described worse clinical outcome in patients treated with atenolol±bendroflumethiazide compared with amlodipine±perindopril.
Imperial College London, 59 North Wharf Rd, London W2 1LA, United Kingdom. anthonybarron@hotmail.co.uk.
Anthony J
AJ
Barron
Alun D
AD
Hughes
Andrew
A
Sharp
Arun J
AJ
Baksi
Praveen
P
Surendran
Richard J
RJ
Jabbour
Alice
A
Stanton
Neil
N
Poulter
Des
D
Fitzgerald
Peter
P
Sever
Eoin
E
O'Brien
Simon
S
Thom
Jamil
J
Mayet
D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001262:Atenolol / Q000008:administration & dosage*; D001539:Bendroflumethiazide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage*; D013995:Time; D017211:Treatment Failure; D016277:Ventricular Function, Left / Q000187:drug effects; D044465:White People
D000959:Antihypertensive Agents; D017311:Amlodipine; D001262:Atenolol; D001539:Bendroflumethiazide; D020913:Perindopril
Doppler; calcium-channel blockers; echocardiography; hypertension; hypertrophy; left ventricular