TIME COURSE AND DEGREE OF REVERSE LEFT VENTRICULAR REMODELLING AND DIASTOLC FUNCTION CHANGE IN SUBJECTS WITH HYPERTENSION

Objective: Hypertension is related to cardiac remodelling and diastolic dysfunction. Reverse cardiac remodelling should be the therapeutic goal of antihypertensive therapy but the time course and degree of LV remodelling (LV+) and diastolic function improvement after initiation/up-titration of antihypertensive treatment are still largely unknown. Here we studied change in left ventricular mass index (LVMI) and diastolic function in a cohort of subjects with hypertension. Design and method: Transthoracic echocardiography including LVMI and study of diastolic function by left atrium volume (LAV) and the ratio (E/E’) between peak mitral early velocity (E) and tissue Doppler annular early diastolic velocity (E’)) was performed at baseline and after 6 months of initiation/up-titration of antihypertensive treatment. Results: 119 subjects (age (mean±SD) 46±11 years, 60% male) were enrolled. Six months after antihypertensive medication initiation/up-titration blood pressure (BP) decreased from 146.7/91.8±14.2/10.2 mmHg to 138.9/87.9±14.9/9.6 mmHg, P<0.001). LVMI, LAV and E/E’ were also significantly reduced: from 87.7±19.7 g/m2, 59.2±18.3 ml and 9.2±2.6 respectively at baseline to 81.9±19.2 g/m2, 55.5±14.8 ml and 8.7±2.6 respectively at 6 months, all P<0.05. At baseline 70 subjects had evidence of LV+ and after stratifying the population according to the presence of LV+ the two groups were superimposable in relation to age, gender, BMI, prevalence of diabetes, dyslipidaemia and blood pressure (BP) values. LVMI was higher in LV+ group compared to subjects with normal geometry (LV-) ((mean±SE) 92.8±20.9 g/m2 vs 80.3±15.07 g/m2, respectively P<0.001) but change in BP (-7.9±2.10 mmHg for LV+ vs -7.6±1.83 mmHg for LV-) and LVMI (-6.4±13.2 g/m2 for LV+ vs -4.9±10.1 g/m2 for LV-) were similar between two groups (both P>0.5). The proportion of subjects in LV+ group decreased from 58% at baseline to 48% at follow up, P<0.001) mostly due to a reduction of subjects presenting with concentric and eccentric hypertrophy (from 5% and 10% respectively to 1% and 7% respectively, P<0.001). Conclusions: Antihypertensive treatment promotes favourable effects in cardiac remodelling and diastolic function within 6 months. Whether more stringent BP control and/or longer time of intervention elicit additional favourable effects warrant further investigations.