Abstract 16804: Long-Term Differential Effects of Amlodipine and Atenolol based Antihypertensive Therapy on Left Ventricular Structure and Function: An ASCOT Sub-Study

Abstract

Background: Both left ventricular hypertrophy (LVH) and impairment of LV diastolic function have been shown to be important predictors of morbidity and mortality in hypertension. Anti-hypertensive treatment can cause regression of LVH and improve LV diastolic function. However little is known about whether these changes are sustained with long term treatment. Methods: Six-hundred and sixty-nine patients (mean age 62 years, 78.9% male) in the ASCOT study who were randomised to either an amlodipine-based regimen (Amlod), or an atenolol-based antihypertensive regimen (Aten) had LV structure and diastolic function assessed by tissue Doppler echocardiography. Measurements were made a median time of 1.48 (Phase 1) and 3.49 (Phase 2) years after randomisation. Results: Blood pressure was lower in Amlod both at phase 1 (141/80 vs 146/83) and phase 2 (138/79 vs 143/82).Left ventricular mass index had significantly improved between Phase 1 and Phase 2 assessment in both treatment groups (Amlod: 119.6 to 116.6 g/m 2 , p=0.007, Aten: 121.8 to 117.2 g/m 2 , p<0.001).At the initial Phase 1 assessment LV diastolic function was better in Amlod compared with Aten (e' 8.5cm/s versus 7.7cm/s, p>0.001; E/e' 7.6 versus 8.1, p=0.008). With a further 2 years of antihypertensive therapy with good BP control there was a small, significant drop in e' but no change in E:e'with Amlod (e' Phase 2 8.1cm/s, versus phase 1 p<0.001; E/e' Phase 2 7.8, versus phase 1 p=0.29); in contrast in Aten there was no change in e' but a small, significant rise in E:e' (e' Phase 2 7.7cm/s, versus phase 1 p=0.59; E/e' Phase 2 8.4, versus phase 1 p=0.02).By the end of the phase 2, after correction for age, gender and systolic blood pressure, e' in Amlod remained significantly higher than aten (p<0.01). Conclusions: Patients with hypertension and good BP control had further regression of LV mass between 1.5 and 3.5 years of antihypertensive therapy with both Amlod and Aten. Those receiving Amlod had better echocardiographic indices of diastolic function at both time points when compared with Aten. Appropriate antihypertensive therapy may lead to early improvement of diastolic function and allow maintenance of a more normal pattern at longer follow-up with improvement in left ventricular mass. Character Count: 1926