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Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular(LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been implicated in the development of LV hypertrophy. This study examines the effects of 48 weeks of double-blind treatment with the AT1 receptor blocker irbesartan and the beta-blocker atenolol on diastolic function. Methods: Diastolic function was evaluated in 115 hypertensive patients with LV hypertrophy by Doppler echocardiography mitral in-flow velocities calculated from the peak of early(E) and peak of late(A) diastolic velocities(E/A ratio), the E-wave deceleration time, the isovolumic relaxation time, the pulmonary venous flow velocity, and by the atrioventricular valve plane displacement method. Results: By similar reductions in blood pressure both groups progressively reduced the LV mass index, with a greater reduction in the irbesartan group(P=0.024). Diastolic function was improved similarly by irbesartan and atenolol; for example, the E/A ratio by 12 and 14%(P=0.022 and P< 0.001), and the pulmonary venous flow velocity by 10 and 7%(P=0.036 and P=0.001), respectively. The isovolumic relaxation time was improved by irbesartan(P=0.040) only, and was related to changes in LV geometry(P< 0.001). For atenolol, improvement in diastolic function was associated only with the reduction in blood pressure(P=0.048). An improvement in diastolic function appeared greater in concentric LV hypertrophy than in eccentric LV hypertrophy. Conclusions: Treatment based on atenolol or irbesartan improves diastolic function in patients with hypertensive LV hypertrophy to the same degree, but through different mechanisms.
Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular (LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been implicated in the development of LV hypertrophy. This study examines the effects of 48 weeks of double-blind treatment with the AT1 receptor blocker irbesartan and the beta-blocker atenolol on diastolic function. Methods: Diastolic function was evaluated in 115 hypertensive patients with LV hypertrophy by Doppler echocardiography mitral in-flow velocities calculated from the peak of early (E) and peak of late (A) diastolic velocities (E / A ratio), the E-wave deceleration time, the isovolumic relaxation time, the pulmonary venous flow velocity, and by the atrioventricular valve plane displacement method. : By similar reductions in blood pressure both groups progressively reduced reduced LV mass index, with a greater reduction in the irbesartan group (P = 0.024). Diastolic funct for example, the E / A ratio by 12 and 14% (P = 0.022 and P <0.001), and the pulmonary venous flow velocity by 10 and 7% (P = 0.036 and P = 0.001), respectively. The isovolumic relaxation time was improved by irbesartan (P = 0.040) only, and was related to changes in LV geometry (P <0.001). For atenolol, improvement in diastolic function was associated only with the reduction in blood pressure (P = 0.048). An improvement in diastolic function greater than concentric LV hypertrophy than in eccentric LV hypertrophy. Conclusions: Treatment based on atenolol or irbesartan improves diastolic function in patients with hypertensive LV hypertrophy to the same degree, but through different mechanisms.