Influence of Perindopril on Left Ventricular Remodeling in Essential and Secondary Hypertension

Abstract

Background: To evaluate the relation between the left ventricular hypertrophy (LVH) regression and changes of LV diastolic function under the influence of perindopril in patients (pts) with hypertension. Methods: Fifty-two pts with essential hypertension (EH) and 36- with secondary arterial hypertension (SAH) of renal genesis with II-III grade hypertension, LVH and abnormal mitral flow pattern have been studied to assess effect of perindopril (up to 4 mg/day) on left ventricular remodeling. Each subject was underwent two-dimensional and Doppler-echocardiography. LV mass index (LVMI), LV end-diastolic diameter (EDD), septal and posterior wall thickness (SWT, PWT) were evaluated, the following parameters of LV diastolic function were assessed by Doppler echocardiographic analysis of the diastolic transmitral flow: the maximal early- (E) and late–(A) velocity of diastolic filling; the E/A ratio, the deceleration time (DT) and the isovolumetric relaxation time (IVRT). Examination was performed at baseline and after 48 weeks of treatment with perindopril. Results: In pts with EH systolic BP (SBP) was reduced on average from 190±22 to 136±10 mm Hg., diastolic BP (DBP) from 113±11.2 to 84±12 mm Hg. In pts with SAH there was detected reduction of SBP and DBP from 206±24 to 142±10 mm Hg and 115±11.1 to 86±11 mm Hg, respectively. LVMI was reduced by 14.2 % in EH and by 13.0 % in SAH (p<0.01 for both). PWT decreased by 12.2 % in EH (p<0.01) and by 7.4 % in SAH (p<0.05), SWT by 6 % (p<0.05) and 14.6 % (p<0.001), respectively. Perindopril treatment produced shortening of IVRT (102.6±4.24 vs 146.8±7.90 ms in EH, and 102.0±2.92 vs 154.0±6.00 ms in SAH, p<0.01 for both), DT (180.0±7.42 vs. 230.0±12.9 ms in EH, p<0.01 and 184.0±7.86 vs. 204.6±9.60 ms in SAH, p<0.05), E (68.8±6.4 vs. 50.0±10.0 cm/s in EH and 56.0±10.3 vs. 46.0±10.0 cm/s in SAH, p<0.05 for both), increased E/A ratio (from 0.82±0.10 to 0.96±0.12 in EH and from 0.70±0.04 to 0.86±0.16 in SAH, p<0.05 for both) and had trend toward decreasing A (68.8±10.0 vs. 86.2±12.0 cm/s in EH and 70.0±10.4 vs. 82.5±12.3 in SAH cm/s, p = NS for both). At the end of follow up normal mitral flow pattern was detected in 46.8 % pts with EH and 39.2 % pts with SAH. Increased in E/A was related to reduction of SWT in pts with SAH (r = 0.69, p<0.05), while in EH at the account of diminution of the LV EDD (r = 0.50, p<0.05). Conclusion: Perindopril treatment has significantly ptoduced the attenuation of the left ventricular remodeling process in pts with EH and SAH. Diastolic function improvement in pts with SAH was related to the reduction of SWT, while in EH -to the reduction of the left ventricular cavity size.