Improvement of diastolic function after reversal of left ventricular hypertrophy induced by long-term antihypertensive treatment with tertatolol

In 15 previously untreated hypertensive subjects with left ventricular (LV) hypertrophy who responded favorably (supine blood pressure ≤140 90 mm Hg) to antihypertensive treatment with a nonselective β-blocking agent, tertatolol, the effects of reversal of LV hypertrophy on systolic and diastolic function were assessed. Patients underwent echocardiographic and radionuclide studies in control conditions (phase 1), after 1 month of blood pressure normalization (phase 2), after reversal of LV hypertrophy or at least a 20% reduction of LV mass compared to basal value (phase 3) and finally, after a 1-month washout (phase 4). In phase 2, Mood pressure (130 ± 2 85 ±1 vs 148 ± 4 104 ±1 mm Hg) and heart rate (59 ± 1 vs 76 ± 2 beats/min) decreased (both p < 0.01); LV mass remained unchanged. There were improvements in peak filling rate (end-diastolic volume/s) (2.4 ±0.1 vs 2.0 ±0.1), ejection fraction (65 ± 1 vs 61 ± 1%) and their ratio (stroke counts/s) (3.7 ± 0.2 vs 3.2 ± 0.1) (all p < 0.05). In phase 3, blood pressure and heart rate were unchanged and reversal of LV hypertrophy was accompanied by a further increase in peak filing rate (2.9 ± 0.1), ejection fraction (69 ± 1%) and their ratio (4.1 ± 0.1) compared to phase 2 (all p < 0.01). Finally, in phase 4 blood pressure and heart rate returned to the basal value, but peak filing rate (2.7 ±0.1) and ejection fraction (65 ± 1%), although reduced compared to phase 3, were stil higher than phase 1. Similarly, the ratio between LV peak filling rate and ejection fraction was increased compared to that in phase 1 (4.1 ± 0.1) (p < 0.01). Thus, LV hypertrophy contributes to LV diastolic dysfunction in hypertensive patients because its reversal can improve diastolic filling; and antihypertensive treatment with tertatolol improves diastolic function independently from its effect on LV mass.