Abstract
The VIPE study was designed to assess the efficacy of candesartan on hypertensive echocardiographic left ventricular hypertrophy (LVH) at short term. In this work we report the effects of the drug on the ventricular geometric pattern and the diastolic function. 97 hypertensive patients (70% females (F) and 30% males (M), age 68.9±9.5 years, BMI 29.3±4.7 kg/m2) with LVH diagnosed by echo were included. LVH criteria were left ventricular mass index (LVMI) ≥134 g/m2 or ≥110 (M or F). The patients were treated with a candesartan-based regimen (8mg, 16mg, +HCTZ 12.5mg, +add-on drugs to target BP <140/90) during a 6-month follow up. Blood pressure (BP): 160.4±11.8/90.4±8.7 mmHg. LVMI: 165.5±32 (M) and 144.6±30.7 g/m2 (F). Relative wall thickness (RWT): 0.46±0.08. Ventricular geometric pattern: 54% concentric LVH (cLVH), 46% eccentric LVH (eLVH). Doppler diastolic parameters: E peak velocity (E) 0.70±0.17 m/sc; A peak velocity (A) 0.87±0.23 m/sc; E/A ratio 0.78±0.21; E wave deceleration time (DT) 223.2±63.1 msc; Isovolumic relaxation time (IVRT) 114.7±21 msc. At 6 months, BP lowered to 141.1±16.8/81.1±10.7 (p<0.001 vs baseline). LVMI reduced 11.3±9.3%. RWT 0.44±0.08 (p<0.05 vs baseline). Ventricular geometry: 32% cLVH, 40% eLVH, 8.5% concentric remodeling and 19.5% normal (p=0.0025 vs baseline). No significant changes were observed in diastolic parameters: E, A, E/A ratio, DT or IVRT. No significant changes were observed in ejection fraction. The drug was very well tolerated and no serious adverse events was reported. The LVH regression observed with a short-term treatment based on candesartan is associated with a significant improvement in ventricular geometry. In almost one fifth of the patients the left ventricular pattern was normalised at six months. No significant changes in diastolic function parameters were observed. These data may suggest that the cardioprotective effects of candesartan could be observed earlier on LVH regression than on diastolic function improvement, what maybe needs more time.
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