IMPACT OF SINGLE-PILL COMBINATION OF VALSARTAN/AMLODIPINE ON LEFT VENTRICULAR HYPERTROPHY AND MYOCARDIAL STIFFNESS IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS

Abstract

Objective: to investigate effects of single-pill combination (SPC) of valsartan/amlodipine (V/A) on left ventricular (LV) and left atrial (LA) myocardial stiffness (MS) parameters and LV mass index (LVMI) in the middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH) without concomitant cardiovascular diseases. Design and method: Retrospective, cohort, open-label study. According to the medical records data a group of naïve patients 40–65 years old with stage II grade 1–2 EAH (n = 38, mean age 49.7 ± 7.0 years) was retrospectively formed. All the patients were treated with V/A SPC and all of them had achieved target office blood pressure (BP) <140/90 mmHg. In all included patients clinical and echocardiographic data (acquired using Vivid 7 Dimension system, GE) were available at baseline and on 12th week after reaching the target BP. LVMI, diastolic interventricular septum thickness (IVS) and diastolic LV posterior wall thickness (PWT) were used as a measures of LV hypertrophy. LV end-diastolic stiffness, LV end-systolic elastance (ESE), LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived LA strain were calculated as MS parameters. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: at the end of follow-up LV ESE significantly (p < 0.001) decreased from 4.01 ± 1.12 to 3.46 ± 0.88 mmHg/ml. In the subgroup of patients with initially abnormal LV GLPS (less than 19.7%) this parameter significantly (p = 0.005) increased in absolute value from −16.14 ± 2.21 to −17.30 ± 2.13% (+8,45 ± 13.35%). All LV hypertrophy markers significantly decreased (p < 0.001 for all) – LVMI from 113.40 ± 22.24 to 103.52 ± 21.30 g/m2 (−8.58 ± 7.57%), IVS from 1.30 ± 0.20 to 1.23 ± 0.19 cm (−5.38 ± 5.29%) and PWT from 1.03 ± 0.11 to 0.95 ± 0.11 cm (−7.82 ± 9.29%). After the treatment with V/A SPC the number of patients with LV hypertrophy significantly (p = 0.039) reduced from 65.8% to 39.5%. Conclusions: in naïve 40–65 years old patients with stage II grade 1–2 EAH antihypertensive therapy with V/A SPC provides effective BP control, improves LV MS parameters and reduced LV hypertrophy.