COMPARISON OF THE EFFECTS OF ISRADIPINE AND LISINOPRIL ON LEFT-VENTRICULAR STRUCTURE AND FUNCTION IN ESSENTIAL-HYPERTENSION

The effects on cardiac structure and function of antihypertensive regimens with different effects on the renin-angiotensin system were compared. In a 1-year study, 32 patients with essential hypertension were randomized to treatment with either the converting enzyme inhibitor lisinopril or the calcium antagonist isradipine; hydrochlorothiazide could be added. Blood pressure (BP) decreased significantly (p < 0.001) and similarly in the 2 treatment groups. Left ventricular (LV) mass was already significantly reduced after 16 weeks of treatment (p < 0.001) and remained decreased thereafter, with no difference in the response to the 2 treatment regimens. The change in LV mass was related to the decrease in systolic BP for the total study group (p < 0.001) and for each treatment group separately. During the 3-week run-out period on placebo, BP and LV mass increased again (p < 0.01). Afterload decreased during active treatment (p < 0.001), and fractional shortening of the LV internal diameter was significantly increased (p < 0.01) to a similar extent in both groups. The ratio of peak mitral flow velocities during atrial contraction and early filling was reduced after 1 year of active treatment in the total study group (p < 0.01); this change was similar in both groups. The data suggest that the regression of LV mass during antihypertensive therapy is mainly related to the decrease in s systolic BP.