Effects Of Antihypertensive Therapy Research Articles

Pilot data on telmisartan short‐term effects on glucose metabolism in the olfactory tract in Alzheimer's disease

The possible effect of antihypertensive therapy on Alzheimer's disease (AD) has been studied, and angiotensin II receptor blockers (ARBs) have been suggested to exert an effect on cognitive decline. The purpose of this study is to clarify the functional effects of telmisartan, a long-acting ARB, on AD brain using prospective longitudinal 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) studies. For this purpose, brain glucose metabolism of four hypertensive patients with AD was examined with FDG-PET before and after administration of telmisartan. Studied subjects underwent three FDG-PET studies at intervals of 12 weeks. Antihypertensive treatment except for telmisartan was started after the first FDG-PET and continued for 24 weeks. Then 40–80 mg of telmisartan was added after the second FDG-PET and continued for 12 weeks.Glucose metabolism was significantly decreased during the first 12 weeks without telmisartan use at an area (−10, 21, −22, x, y, z; Z = 3.56) caudal to the left rectal gyrus and the olfactory sulcus corresponding to the left olfactory tract. In contrast, the introduction of telmisartan during the following 12 weeks preserved glucose metabolism at areas (5, 19, −20, x, y, z; Z = 3.09; 6, 19, −22, x, y, z; Z = 2.88) caudal to the bilateral rectal gyri and olfactory sulci corresponding to the bilateral olfactory tracts. No areas showed decreased glucose metabolism after the introduction of telmisartan. In AD, amyloid-β deposition is observed in the anterior olfactory nucleus (AON) of the olfactory tract. Glucose metabolism in AON may be progressively decreased and preserved by telmisartan.

The relationship between antihypertensive therapy and renal function in 152 hypertensives

Objective: To observe the effects of antihypertensive therapy on serum creatinine (CRE) and estimated glomerular filtration rate (eGFR) in hypertensive patients. Methods: Totally 152 hypertensives were randomly divided into four groups (group A: amlodipine+telmisartan, B: amlodipine+amiloride, C: amlodipine+telmisartan+simvastatin, D: amlodipine+amiloride+simvastatin). They were followed for 2 years. Results: After 3 months of treatment, means of SBP and DBP declined within normal range for four groups (P<0.001). After 1 year of treatment, mean of CRE was significantly decreased by 13.51 umol/L (t=9.796, P<0.001); eGFR was significantly increased by 27.4 mL/min/1.73m2 (t=−7.178, P<0.001). After 2 years of treatment, means of SBP and DBP decreased by 28.16 mmHg and 10.07 mmHg, respectively (t=24.731, P<0.001); CRE decreased by 19.17 umol/L (t=13.69, P<0.001); eGFR was increased by 43.23 umol/L (t=−11.048, P<0.001). Means of CRE and eGFR among the four groups did not have differences (P>0.05). Conclusions: The effects of the combination of two antihypertensive drugs in hypertensives are significant, it can not only decrease BP and CRE, but also increase GFR. Decreasing BP can protect the kidney and improve the renal function. Different antihypertensive drugs had no significant difference in benefiting the renal function.

Plasma fibrin clot properties in arterial hypertension and their modification by antihypertensive medication

BackgroundWe sought to determine plasma fibrin clot properties in hypertensive subjects and to evaluate potential effects of antihypertensive therapy on these parameters. Patients and MethodsSixty-one patients (30 men, 31 women) with essential arterial hypertension stage 1 or 2 (aged 46.6±14.4years), free of clinically evident vascular disease, were randomly allocated for monotherapy with one of the 5 antihypertensive agents, i.e. quinapril, losartan, amlodipine, hydrochlorothiazide, or bisoprolol. Plasma fibrin clot permeability, turbidimetry and efficiency of fibrinolysis were investigated at baseline and after 6months of therapy. ResultsBaseline systolic blood pressure in a 24-hour ambulatory monitoring was correlated with clot permeability (r=−0.37, p<0.05), lysis time (r=0.42, p<0.05) and maximal D-dimer concentration released from clots (r=0.45, p<0.05). Antihypertensive treatment resulted in reduction of systolic/diastolic blood pressure in office measurements and 24-hour monitoring (all p<0.001), accompanied by an increase in clot permeability, reduction in clot lysis time and lower maximal D-dimer concentration released from fibrin clots (all p<0.05). No changes were observed in turbidimetric variables. Posttreatment changes in plasma fibrin clot properties were related to reductions in systolic blood pressure, complement component C3 and total cholesterol. ConclusionsReduction in systolic blood pressure during antihypertensive treatment leads to increased plasma fibrin clot permeation and susceptibility to lysis, which might be a novel antithrombotic mechanism of blood pressure lowering therapy.

The Impact of Antihypertensive Drug Therapy on Endotoxemia in Elderly Patients with Chronic Kidney Disease

Endotoxin (ET) is recognized to cause adverse effects on cardiovascular (CV) structure. Circulatory translocation of gut bacterial ET is described in heart failure. Chronic kidney disease (CKD) is common in older people and aggressive BP control is the cornerstone of management. We therefore studied ET after improvement of the overall CV milieu with introduction of optimized antihypertensive therapy (AHT). We recruited 40 hypertensive nondiabetic patients (≥70 years) with CKD stages 3 and 4 and hypertensive non-CKD matched controls. Assessment was performed after complete AHT washout and repeated after AHT reintroduction to target BP 130/80 mmHg. Pulse wave velocity (PWV) and analysis were assessed by applanation tonometry, central hemodynamics by continuous digital pulse wave analysis, vascular calcification (VC) by superficial femoral artery CT, and serum ET by Limulus Amebocyte assay. Mean age was 76 ± 5 years, estimated GFR (eGFR) (CKD group) was 40 ± 14 ml/min per 1.73 m(2), and achieved BP was 128/69 mmHg. Washout ET was 0.042 ± 0.011 EU/ml and was independent of renal function, gender, age, BP, VC, arterial stiffness, and high-sensitivity C-reactive protein. ET significantly decreased with AHT (to 0.020 ± 0.028 EU/ml; P < 0.001) and was associated with eGFR (R = -0.38; P = 0.02), arterial wave reflection (Augmentation Index R = -0.42; P = 0.01), and degree of tonic vasodilatation (total peripheral resistance R = -0.37; P = 0.03), but not VC, PWV, gender, age, BP, or high-sensitivity C-reactive protein. Elderly patients with hypertension have elevated serum ET. Improvement of their CV status with optimized AHT is associated with a significant reduction in endotoxemia. Further investigation of the potential pathophysiological mechanisms linking CV disease and CKD with this previously unappreciated effect of AHT appears warranted.

Early left ventricular remodelling criteria and antihypertensive therapy effectiveness

Aim.To identify the criteria of early left ventricular (LV) remodelling; to assess the baseline structure and function of left and right cardiac chambers, as well as their dynamics during adequate antihypertensive therapy (AHT), in patients with Stage 2 arterial hypertension (AH).Material and methods.In total, the study included 79 individuals: 35 patients with Stage 2 AH and 44 healthy volunteers. All participants underwent echocardiography (EchoCG), with the assessment of standard structural and functional remodelling parameters, as well as the original linear parameters “a”, “b”, and “c”, proposed by the authors. Twenty five AH patients were re-examined 1,5 years after the start of adequate AHT.Results.Even early stages of AH are characterised by left and right ventricular dysfunction, as a manifestation of complex heart reaction to pressure overload. Simple, accessible EchoCG criteria, specifically, linear parameters of LV geometry “a”, “b”, and “c”, have been proposed to assess LV remodelling at earlier stages, compared to traditional parameters and spherical index. Adequate AHT resulted in improvement of left and right heart structure and function, with geometric parameters “a” and “b” being the most sensitive criteria.Conclusion.In AH patients, the proposed linear parameters could be used as diagnostic criteria for earlyLV remodelling, as well as indicators of AHT effectiveness, considering their higher sensitivity, compared to traditional EchoCG parameters.

Effect of antihypertensive therapy on the life quality of patients with hypertensive encephalopathy

To analyze patients with hypertensive encephalopathy (HE) in the course of antihypertensive therapy (AT) clinical psychological and neurological characteristics in dynamics of 6 months after the first screening were estimated. 107 patients with HE of I—III stages and 30 controls matched for age and sex were examined. The clinical, ultrasonic diagnostics and quality of life (QL) index were applied. In the process of HE development and progression decreases of the physical and psychological constituents of health were shown, pain barrier was decreased. The QL analysis shown that in the process of AT in dynamics the physical and psychological constituents of health increase.

Vascular tone auto-regulation in young men with arterial hypertension: antihypertensive therapy effects

Aim. To assess vaso-regulating endothelial function and vascular tone auto-regulation status, in regard to arterial hypertension (AH) duration and stage, as well as to investigate the respective effects of antihypertensive therapy (AHT), in young men with AH. Material and methods. The study included 49 men with Stage I-II AH (mean age 39,3±0,8 years), not treated before or treated irregularly. The controls were 22 men with normal blood pressure (BP) levels (mean age 37,5±1,7 years). The examination included 24-hour BP monitoring (BPM) and assessment of endothelium-dependent vasodilatation (EDVD) and time-adjusted mean arterial velocity (TAMX) in functional tests. Results. In young men with Stage I-II AH, in contrast to normotensive men, EDVD and reactivity indices (RIs) were decreased in functional TAMX assessment tests. These changes in EDVD and RIs were observed even in patients with relatively short AH duration or Stage I AH. Effective AHT resulted not only in target BP level achievement, but also in normalisation of EDVD and vascular tone auto-regulation. Conclusion. ACE inhibitors (lisinopril and enalapril) normalised EDVD and vascular tone auto-regulation parameters in young men with AH.

Structural abnormalities of small resistance arteries in essential hypertension

Regardless of the mechanisms that initiate the increase in blood pressure, the development of structural changes in the systemic vasculature is the end result of established hypertension. In essential hypertension, the small arteries smooth muscle cells are restructured around a smaller lumen, and there is no net growth of the vascular wall, while in some secondary forms of hypertension, a hypertrophic remodeling may be detected. Also, in non-insulin-dependent diabetes mellitus, a hypertrophic remodeling of subcutaneous small arteries is present. The results from our own group have suggested that indices of small resistance artery structure, such as the tunica media to internal lumen ratio, may have a strong prognostic significance in hypertensive patients, over and above all other known cardiovascular risk factors. Therefore, the regression of vascular alterations is an appealing goal of antihypertensive treatment. Different antihypertensive drugs seem to have different effect on vascular structure, both in human and in animal models of genetic and experimental hypertension. A complete normalization of small resistance artery structure is demonstrated in hypertensive patients, after long-term and effective therapy with ACE inhibitors, angiotensin II receptor blockers and calcium antagonists. Few data are available in diabetic hypertensive patients; however, blockade of the renin-angiotensin system seems to be effective in this regard. In conclusion, there are several pieces of evidence that suggest that small resistance artery structure may be considered an intermediate endpoint in the evaluation of the effects of antihypertensive therapy; however, there are presently no data available about the prognostic impact of the regression of vascular structural alterations in hypertension and diabetes.

Eprosartan-based hypertension therapy, systolic arterial blood pressure and cognitive function: analysis of Middle East data from the OSCAR study

Background:Studies have indicated a relationship between hypertension and cognitive function. The possible effect of antihypertensive therapy on cognitive disorders is therefore a matter of interest.Materials and methods:The Observational Study on Cognitive function And SBP Reduction (OSCAR) was an open-label, multinational trial designed to evaluate the impact of eprosartan-based antihypertensive therapy on cognitive function in patients with essential hypertension. Eprosartan 600 mg/day for 6 months (with provision for additional medication as needed) was initiated in hypertensive subjects aged ≥50 years. A total of 853 patients in an intention-to-treat cohort from seven countries of the Middle East was identified for subgroup analysis.Results:Arterial blood pressure was reduced significantly (P < 0.001) during the study: At the end of 6 months of eprosartan-based therapy, the mean (±SD) reduction from baseline was 32.1 ± 14.3/14.6.3 ± 8.6 mmHg (P < 0.001). Mean pulse pressure was reduced by 18.3 ± 13.1 mmHg (P < 0.0001 vs baseline). Blood pressure was normalized (systolic <140 mmHg and diastolic <90 mmHg) in 68.2% of patients. The overall mean Mini-Mental State Examination (MMSE) score after 6 months of eprosartan-based therapy was one-point higher than at baseline (P < 0.001). MMSE score on completion of 6 months’ follow-up was either unchanged or increased from baseline in 793 (93%) individuals and decreased in 60 (7%). Factors associated with stability of or improvement in cognitive function included MMSE score at baseline, diastolic blood pressure (DBP) at baseline, and treatment-induced change in DBP.Conclusion:Results from the Middle East subgroup of OSCAR are supportive of the hypothesis that antihypertensive therapy based on angiotensin-receptor blocker therapy with eprosartan may be associated with preservation or improvement of cognitive function.

DIFFERENCES IN EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN MEN AND WOMEN: LOSARTAN VERSUS ENALAPRIL

Aim. To evaluate gender differences in effectiveness of antihypertensive therapy with losartan in comparison with enalapril therapy. Material and methods. Open-label controlled crossover study in parallel groups was conducted during 3 months. A total of 120 patients aged 20-45 years with arterial hypertension (HT) of 1 and 2 degree were split into 4 groups with 30 patients in each: 1A, 1B – men; 2A, 2B – women. For the first 6 weeks patients of the 1A, 2A groups received enalapril 5-20 mg while patients of 1B, 2B – received losartan 50-100 mg. Then the therapy was crosswise changed. Results. Initial blood pressure (BP) levels did not differ significantly in men and women. In women start therapy with losartan decreased systolic BP (BPs) more effectively than enalapril therapy did (18.2±5.4% vs 15.2±4.3%, р=0.02). In men enalapril and losartan start therapies did not show significant differences in BP reduction (13.8±4.5% vs 14.6±4.6%, р=0.539). Follicule-stimulating hormone (FSH) level in women correlated positively with age (r=0.826; p=0.0001), HT duration (r=0.498; p=0.0001), BPs level (r=0.466; p=0.001), microalbuminuria level (r=0.583; p=0.0001) and negatively – with glomerular filtration rate (r=-0.58; p=0.0001). Conclusion. Losartan is more effective than enalapril as a start therapy in 20-45-year-old women. In women FSH level correlates with age, HT duration, BPs and microalbuminuria levels, glomerular filtration rate.

Arterial Stiffness in Chronic Kidney Disease: The Usefulness of a Marker of Vascular Damage

Increased arterial stiffness is a marker of vasculopathy in chronic kidney disease (CKD) patients, suggesting a significant cardiovascular damage. Detection of arterial stiffness provides physicians with useful prognostic information independent of traditional cardiovascular (CV) risk factors. In addition, this knowledge may help guide appropriate therapeutic choices and monitor the effectiveness of antihypertensive therapies. We review the relationship between arterial stiffness and CKD, as well as the prognostic implications of increased arterial stiffness and the potential therapeutic strategies to ameliorate arterial compliance and outcome in CKD.

カンデサルタンシレキセチルが本態性高血圧患者の尿中蛋白排泄に与える影響

It has been reported that hypertensive renal damage occurs not only in the glomerulus but also in the renal tubule.However,the excretion of urinary proteins other than albumin has not been sufficiently evaluated in hypertensive patients.Theaim of this study was to study the effect of antihypertensive therapy with candesartan cilexetil on urinary protein excretion.Twenty-nine hypertensive patients were enrolled in it.The target of the antihypertensive therapy was less than 140/90mmHg or a reduction of more than 20/10 mmHg.In 20 patients,the therapy decreased blood pressure significantly (from161.1±14.3/95.3±11.6 mmHg to 132.7±7.6/82.8±7.0 mmHg) (p<0.001/p<0.001).Total urinary protein excretion wasalso significantly decreased (from 97.7±49.1 to 66.8±30.9 mg/gCr) (p=0.009).When urinary proteins were electrophoresed using SDS-PAGE,the content of 6 fractions (100 kD,82 kD,64 kD,23 kD,22 kD and 11 kD) was significantly decreased after treatment (p=0.024,0.044,0.009,0.048,0.044,and 0.017,respectively).In 9 patients in whom blood pressure was not lowered sufficiently,total urinary protein excretion and all of theabove urinary protein fractions were decreased,though not significantly.These results suggest that if antihypertensive therapy with candesartan cilexetil lowers blood pressure sufficiently,the excretionof total urinary protein and some glomerular and tubular urinary proteins would also be adequately decreased.Also,the influence of the treatment in this study on urinary protein excretion might differ depending on the urinary protein factions.

Systematic review of the effect of anti-hypertensive drug therapy on arterial stiffness

Systematic review of the effect of anti-hypertensive drug therapy on arterial stiffness

Effects of bisoprolol and cilazapril on the central retinal artery blood flow in patients with essential hypertension—preliminary results

Background. A growing body of evidence suggests that effective blood pressure reduction may inhibit the progression of microvascular damage in patients with essential arterial hypertension. However, the potential influence of anti-hypertensive drugs on ocular circulation has not been studied sufficiently.Purpose. The aim of our study was to evaluate the effects of anti-hypertensive therapy on blood flow in the central retinal artery in patients with systemic arterial hypertension.Material and methods. Twenty patients with essential arterial hypertension, aged 32–46 years, were examined with Doppler ultrasonography (10 MHz ultrasound probe). Blood flow velocities, pulsatility, and vascular resistance were determined before and 3 hours after systemic application of either bisoprolol 5 mg or cilazapril 2.5 mg.Results. Administered bisoprolol significantly decreased maximum (9.8 ± 0.5 cm/s versus 8.5 ± 0.6 cm/s; P < 0.05) and minimum (2.75 ± 0.19 cm/s versus 1.75 ± 0.27 cm/s; P < 0.02) velocity, increased the Pourcellot's index (0.71 to 0.79; P < 0.05) in central retinal artery. There were no statistically significant changes in central retinal artery blood flow after administration of cilazapril.Conclusion. Systemic application of beta-blockers may unfavourably disturb the ocular blood flow.

Acute Stroke

Not much progress has occurred in guidelines to treat blood pressure (BP) during acute stroke since Sir George Pickering wrote in 1968 about cerebral hemorrhage: “Probably diastolic pressures over 110 are worth reducing to 90 mm Hg. This is a guess, and theoretical arguments could be urged against, or for, different figures,” and about ischemic stroke: “There is no evidence that reducing arterial pressure in the acute phase will help.”1 Perhaps the different purposes of treating BP for the prevention of stroke versus managing BP during its acute phase explain this. In the former, BP reduction (and blockade of vasoactive systems) aims at reducing arteriolar remodeling and arterial atherosclerosis, the culprits for both intracerebral hemorrhage (ICH) and ischemic strokes. Its effectiveness has been unequivocally proven; stroke prevention is quantitatively the most beneficial effect of antihypertensive therapy. In contrast, the purpose of managing BP during an acute stroke is to improve outcomes by diminishing the magnitude of the bleed, or the development of edema in the ischemic region, or the extension of tissue necrosis into the penumbra. The physiology of the hypertensive cerebral circulation, before and during a stroke, is complex and contributes to the fact that achieving one of the goals above may conflict with achieving another one. Normal autoregulation of cerebral blood flow (CBF) maintains it constant over a wide range of mean arterial pressures (MAPs; ≈50 through ≈150 mm Hg; FigureA). BPs above these limits will produce cerebral edema. In contrast, below the lower limit (located at ≈75% of usual MAP), hypoperfusion does not cause immediate ischemia, because the brain is capable of increasing O2 extraction (thick portion of the curve in the Figure). Cerebral hypoxemia ensues if additional hypotension overwhelms this compensation. Figure. Schema of autoregulation of cerebral blood flow. MAP indicates mean arterial …

Vascular Effects of Antihypertensive Drug Therapy

Hypertension is associated with structural and functional alterations in the vasculature that lead to hemodynamic disturbances and target organ damage. The benefit of reducing blood pressure on risk reduction is well established. Antihypertensive drugs partially correct hypertensive vascular changes by a number of mechanisms, but their influence may vary in different vascular beds. Recently, combinations of drugs with complementary or synergistic effects have shown favorable effects on the vasculature; these combinations may contribute to risk reduction and improve outcomes in the future. Clinical trial evidence has shown an improvement in morbidity and mortality indicators that could be related to vascular effects of antihypertensive drugs, but this effect needs to be proven in future long-term prospective studies involving simultaneous evaluation of small-artery and large-artery properties.

SHORT-TERM EFFECTS OF LOSARTAN THERAPY ON HAEMODYNAMIC PARAMETERS IN HYPERTENSIVE PATIENTS: PP.5.223

Objectives: The aim of this study was to assess the short-term effects of antihypertensive therapy with losartan, alone or combined with hydrochlorthiaside, on blood pressure and hemodynamics parameters of hypertensive patients. Design and Methods: The study comprised 76 patients (36 men and 40 women) with arterial hypertension (grade I or II), aged 60.93 ± 10.51 years. Ambulatory 24-hour blood pressure monitoring (ABPM, using Space Labs 90202) and thoracic bioelectric impedance (TBI, using Task-Force monitor) were performed to estimate haemodynamic parameters (peripheral vascular resistance, PVR, and blood volume, BV). The subjects who had increased PVR [32 patients (12 men and 20 women)] were treated with 50 mg losartan per day. Those with increased both PVR and BV [44 patients (21 men and 23 women)] were treated with 50 mg losartan and 12.5 mg hydrochlorthiaside per day. Short-term effects of therapy were assessed after 30 and 60 days. Results: After a two months therapy both groups experienced a significant decrease of blood pressure. Patients with increased PVR responded to losartan therapy with significant decrease of PVR after 30 and 60 days (PVRbeginning=68.5 ± 14.0; PVR30days=36.0 ± 11.5; PVR60days=9.5 ± 9.0; p < 0.001). The group treated with losartan and hydrochlorthiaside showed significant decrease of PVR (PVRbeginning=42.5 ± 11.0; PVR30days=26.5 ± 10.0; PVR60days=15.5 ± 9.0; p < 0.001) and blood volume (BVbeginning=39.0 ± 12.0; BV30days=22.0 ± 9.5; BV60days=11.0 ± 8.5; p < 0.001). Heart rate remained unchanged during the treatment in both groups. Conclusion: Short-term therapy of losartan in patients with arterial hypertension was efficient in reducing blood pressure and peripheral vascular resistance. The combination of losartan and hydrochlorthiaside could in addition reduce patient's blood volume.

Effect of antihypertensive therapy with α‐methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders

Antihypertensive drugs lower blood pressure by direct vascular effects or central vasodilatory mechanisms. Their effect on uterine artery Doppler resistance indices in hypertensive disorders of pregnancy is uncertain. This study aimed to evaluate the impact of antihypertensive therapy with alpha-methyldopa on maternal uterine artery Doppler pulsatility index (PI) and resistance index (RI) in women presenting with hypertensive disorders of pregnancy. This was a cross-sectional study of 51 women with pre-eclampsia, 29 with gestational hypertension and 80 matched normotensive controls. Uterine artery PI and RI were measured at recruitment (between 24 and 40 weeks' gestation) and, in the hypertensive groups, 24-48 h after starting alpha-methyldopa. Differences between mild and severe, and between early- and late-onset pre-eclampsia were compared using the Mann-Whitney test. The Wilcoxon rank sum test was used to compare measurements before and after treatment. Prior to treatment, uterine artery PI and RI were significantly higher in women with pre-eclampsia compared with those with gestational hypertension and controls (P < 0.0001). The median uterine artery PI multiple of the median (MoM) was significantly higher (P < 0.0001) in early-onset than in late-onset pre-eclampsia (1.83 (range, 0.88-3.65) vs. 1.19 (range, 0.91-1.72)) and in severe compared with mild disease (2.26 (range, 2.02-3.65) vs. 1.29 (range, 0.88-2.9)). Uterine artery PI- and RI-MoMs in both pre-eclampsia and gestational hypertension, before and after 34 weeks' gestation, were not affected by alpha-methyldopa treatment. Antihypertensive therapy using alpha-methyldopa in women presenting with hypertensive disorders of pregnancy has no significant effect on uterine artery resistance to blood flow, suggesting that it does not impair uteroplacental circulation in these cases.

Improvement of left ventricular mass with antihypertensive therapy in children with hypertension

There is paucity of data on the regression of left ventricular hypertrophy (LVH) in hypertensive children. This study assessed the effects of antihypertensive therapy on left ventricular mass in children with and without LVH. Medical records of hypertensive patients who had a baseline and follow-up echocardiogram (echo 1, echo 2) were reviewed. Fifteen of 22 treated patients had LVH at echo 1. Enalapril alone or combined was used in 21/22 cases. Echo 2 was performed at a mean interval of 15 +/- 7 months. The LVH group showed significant decrease in systolic blood pressure z-score (SBPZ) (2.89 +/-1.61 to 1.40 +/- 1.19; p=0.01), diastolic blood pressure z-score (DBPZ) (1.44 +/- 0.90 to 0.26 +/- 0.82; p<0.001), and LV mass index (LVMI) (56.2 +/- 12.50 to 43.7 +/- 8.30; p=0.001), but no significant change in body mass index z-score (BMIZ) (1.79 +/- 0.75 to 1.69 +/- 0.69; p=0.74). In the no-LVH group, SBPZ (3.03 +/- 1.68 to 2.27 +/- 1.81; p=0.356), DBPZ (1.00 +/- 0.87 to 0.63 +/- 0.68; p=0.409), BMIZ (1.08 +/- 0.98 to 1.27 +/- 0.89; p=0.672), and LVMI (29.47 +/- 5.51 to 33.89 +/ -3.06;p=0.374) did not change significantly. Simple linear regression demonstrated that the change in LVMI in the combined group had a significant correlation (r=0.477; p=0.025) with the percentage change in SBPZ. This study demonstrates that LVH in hypertensive children improves with effective blood pressure control.

Effect of antihypertensive drug therapy on short‐term heart rate variability in newly diagnosed essential hypertension

1. Abnormalities of cardiac autonomic regulation are a potential mechanism for morbidity despite blood pressure (BP) lowering in hypertension. Analysis of short-term (5 min) heart rate variability (HRV) provides a non-invasive probe of autonomic regulation of sino-atrial (SA) node automaticity. 2. We hypothesized that antihypertensive drug therapy would be associated with an increase in 5 min overall HRV, along with a decrease in blood pressure (BP), at 8 weeks follow up in subjects with newly diagnosed, never-treated essential hypertension. 3. One hundred and fifty patients (84 men and 66 women; mean (+/-SD) age 48 +/- 10 years) with newly diagnosed essential hypertension were divided to five groups of 30 patients each to receive one of the following antihypertensive drugs (or drug combinations): 5 mg/day amlodipine; 50 mg/day atenolol; 5 mg/day enalapril; 25 mg/day hydrochlorothiazide; or a combination of 5 mg/day amlodipine and 50 mg/day atenolol. 4. The only significant change in HRV indices was an increase in total variability of RR intervals and an increase in high-frequency (HF) RR interval spectral power in the amlodipine + atenolol-treated group (P < 0.05). 5. The results indicate that there is a dissociation between changes in short-term HRV and mean RR interval and BP lowering in patients with newly diagnosed hypertension. 6. We interpret the increase in HF RR interval spectral power in the amlodipine + atenolol-treated group as being due to an increase in vagal modulation of RR intervals and/or diminution in sympathetic restraint of respiratory sinus arrhythmia.