Impact of a low-dose combination of isradipine SRO and spirapril on left ventricular mass and left ventricular performance in patients with hypertension and left ventricular hypertrophy

摘要

Objective: This study investigated the effects of a low-dose fixed combination of the ACE inhibitor isradipine SRO (slow-release oral) and the calcium antagonist spirapril on left ventricular hypertrophy (LVH) in patients with mild to moderate hypertension and LVH. Design: Open, non-randomised preliminary study. Subjects: 20 patients (11 men and nine women, mean age 62 ?12 years) with arterial hypertension and LVH were included in the study. Methods: ECG-triggered nuclear magnetic resonance tomography (MRT), echocardiography and radionuclide ventriculography were used to measure parameters of left ventricular function at baseline and after 12 weeks' treatment with a fixed combination of isradipine SRO 2.5mg and spirapril 3mg once daily. Results: Diastolic blood pressure was normalised (< less-than-or-equal-to >90mm Hg) after 6 weeks in 19 of 20 patients; only one patient required the dosage to be doubled to achieve BP control. Mean blood pressure was reduced from 163/99mm Hg at baseline to 150/84mm Hgat the end of the study (2p < 0.001). Mean end-systolic interventricular septum thickness measured by MRT was reduced from 20.1 to 18.2mm (2p < 0.001) after 12 weeks and end-systolic left ventricular posterior wall thickness from 19.2 to 17.7mm (2p<0.001). Echocardiographic assessments resulted in similar findings. The left ventricular mass index calculated from echocardiographic data decreased from 195 to 164 g/m2 (2p < 0.001). A marked drop in total peripheral resistance from 1470 to 1233 units (2p < 0.001) was paralleled by a 14% decrease in systolic wall tension and an improvement in peak ventricular filling rate. Although there was a significant reduction in left ventricular mass, parameters of cardiac work did not change significantly, thus indicating a more efficient ventricular performance during treatment. Conclusion: In this preliminary study, a low-dose combination of isradipine and spirapril induced a significant regression in LVH and an improvement in haemodynamic parameters in patients with mild to moderate hypertension and LVH. This finding needs to be confirmed in larger-scale, controlled studies.