13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-155

Myocardial remodeling in hypertensive patients. The role of converting enzyme inhibitors and angiotensin II receptor blockers in reducing ventricular arrhythmia

Pablo I. Altieri, Robert González, Nelson Escobales, María Crespo, Héctor Banch.
Department of Medicine and Physiology, University of Puerto Rico Medical Science Campus, USA

Hypertrophy

Left ventricular hypertrophy is an important risk factor for an increase in the morbidity and mortality of the hypertensive patient, because this abnormality will increase the prevalence of ventricular arrhythmias^1-4. We will report in our data how regression of left ventricular mass with converting enzyme inhibitors and Dup 753 (angiotensin II receptor blocker) will reduce the prevalence of this arrhythmia. Also we will discuss possible mechanisms, why this occurs.

The patients were selected from the hypertensive clinic and they were untreated until that point⁵. Those selected were 25 patients with echocardiographic evidence of increased left ventricular mass index (> 116 g/m² in men and 106 g/m² in women) and mild to moderate systemic hypertension.

During the 2 weeks run in period, baseline laboratory data, blood pressure measurements and echocardiograms were done including in all data on left ventricular mass⁶ done in accordance to the stress calculated by a modified Janz⁷ method.

Twenty-five patients received enalapril 10 mg twice a day for 24 months. Echocardiographic and hemodynamic findings were assessed at baseline and after 6, 12, 18 and 24 months. The blood pressure was reduced from 165 ± 17/102 ± 5 mmHg (p < 0.001), after 6 months and remained at those levels there after.

Table A-I shows the reduction in left ventricular mass index. As seen there is a slow reduction of mass which peaks at 24 months.

TABLE A-I - Reduction in left ventricular mass index

Table A-II and A-III show the progressive reduction of posterior wall and interventricular wall thickness which peaks at 18 months. The left ventricular cavity and wall changes are shown in table A-IV. As clearly seen, there is an increase in cavity area with a concomitant reduction in wall area. Normalization of left ventricular mass index in all patients required 24 months of therapy.

TABLE A-II - Reduction in posterior wall thickness

TABLE A-III - Reduction in interventricular septal thickness

TABLE A-IV - Chanes in left ventricular cavity and wall area