Abstract
BACKGROUND: There is controversy regarding whether blood pressure (BP) medications have relevant therapeutic benefits beyond those due to lowering of BP. OBJECTIVE: To show that rapid successful treatment of hypertension leads to improvement in cardiac morphology and function regardless of the pharmacological agents used. METHODS: Hypertension was defined as an average 24 h ambulatory BP of higher than 135/85 mmHg in 38 subjects with a mean (+/- SD) age of 54+/-7 years. Patients were randomly assigned to treatment with a diuretic based (n=20) or a calcium channel blocker (CCB)-based (n=18) medication. All subjects were followed every two weeks, and similar additional medications were added until the BP was lower than 125/80 mmHg, then followed monthly for a total of six months. Echocardiography with tissue Doppler imaging was performed, and was repeated after six months of aggressive pharmacotherapy and lifestyle management. RESULTS: Baseline ambulatory BP monitoring and echocardiographic measures of diastolic function were similar between both treatment groups. Subjects received 3.5+/-1 pills and 11+/-2 follow-up visits. The average 24 h BP was reduced from 145/91 mmHg to 124/75 mmHg (P<0.001) in the CCB group. A greater lowering from 143/91 mmHg to 117/72 mmHg occurred in the diuretic group (P=0.02 for the difference between groups) at six months. There was significant improvement in tissue Doppler imaging diastolic function parameters in both groups, with a trend toward greater improvement in the diuretic group. The left ventricular mass/ height(2.7) index decreased from 40 g/m(2.7) to 37 g/m(2.7) in the diuretic group (P=0.02), whereas a nonsignificant change (41 g/m(2.7) to 42 g/m(2.7)) occurred in the CCB group. CONCLUSIONS: Aggressive BP lowering is associated with improved left ventricular diastolic function and mass proportional to the extent of BP normalization.