Normalization of LVH with ACE Inhibitors
Even though beta blockers and diuretics remain first-line choice of pharmacologic therapy in otherwise uncomplicated hypertension patients, meta-analyses have demonstrated that ACE inhibitors are more effective in regards to reversing left ventricular hypertrophy (LVH). The time-course of LVH reversal, whether the LVH can be reversed totally or just reduced, and whether atrial mass can be reduced were all objects of study in this investigation.
Franz et al selected 23 previously untreated hypertensive men and women with echocardiographically confirmed LVH. The study subjects received an ACE inhibitor (quinapril 10-20 mg/d) for three years. HCTZ 25 mg was added to the regimen of three patients whose BP control was inadequate after maximum ACE inhibitor. During this time, the subjects were monitored every six months by echocardiography, ambulatory blood pressure monitoring, and exercise treadmill testing.
By six months, there was a 17.5% decrease in LVH, which progressively continued to decline on treatment so that by 38 months of therapy, left ventricular mass had decreased 38.6%. In essence, more than 90% of patients with LVH achieved complete regression by about three years. Improvement in the echocardiographic E/A ratio (evidence of reduced diastolic dysfunction) improved in the first 7.5 months of therapy and remained stable thereafter. Left atrial enlargement was also normalized in 86% of patients by about 38 months of ACE inhibitor treatment.
The authors conclude that ACE inhibitor therapy with quinapril effectively regresses LVH as well as left atrial enlargement over the short term (6 months or less) and, by three years, allows full normalization of these aspects in most patients.
Franz I, et al. Am J Hypertens 1998; 11:631-639.
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