The effects of antihypertensive therapy on left ventricular mass in elderly patients

Article Abstract:

The effects of reducing blood pressure on risk of cardiovascular disease in older people is well known, but results of reducing the mass of the left ventricle (the chamber of the heart that pumps blood to the body) have been less well characterized. Forty-two patients (average age, 68) who took one of two drugs that reduce blood pressure were examined. The subjects also had undergone echocardiographic (ultrasound) studies that indicated they had a left-ventricular wall thickness of 1.2 centimeters or more. The patients received a placebo (inactive) drug for at least one week, during this time blood pressure readings were between 160 and 220 mm Hg systolic (pressure during the contracting phase of the heart's cycle) and 90 and 115 mm Hg diastolic pressure (measured during the resting phase). Echocardiography and a measurement of left ventricular mass were performed. One of two drugs were randomly assigned to the subjects. Half of the patients received a beta-adrenergic blocker (atenolol); the other half were given a calcium-channel blocker (verapamil). If blood pressure was not reduced to a level of 160/90 or lower after four weeks, another drug, chlorthalidone, was added. The results showed that blood pressure control was maintained throughout the six months, although atenolol patients more frequently required chlorthalidone to achieve a control level. Verapamil produced a greater reduction in blood pressure than atenolol. Left-ventricular mass was reduced by 18 percent in the verapamil group; no change was observed in the atenolol group. Details of size of these changes were provided. Verapamil also produced changes in two variables associated with ventricular filling during diastole for patients that showed decrease in mass. It appears that verapamil reduces blood pressure and left ventricular mass better than atenolol in elderly patients with mild left ventricular enlargement, and also improves diastolic filling. No reduction in cardiac output during rest or exercise was noted with either drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Reversing cardiac hypertrophy in hypertension

Article Abstract:

One way the heart adjusts to increased workloads is through the addition of contractile units to the muscle cell, the portion of the cell that contracts to exert force. This process usually balances the increased stress on the ventricular wall (the chamber that pumps blood to the body), but hypertrophy (increased size) can also occur in pathological cases. The electrocardiogram (ECG) can detect extreme cases of ventricular hypertrophy, but echocardiography (ultrasound) is more useful in evaluating changes over time in less severe cases. In fact, echocardiography is thought to detect 7 to 10 times more people with left ventricular hypertrophy than can be detected using ECG. This implies that older data based on ECG records may not be useful in assessing the extent of the problem. A study in the May 10, 1990, issue of The New England Journal of Medicine showed that, while both atenolol (a beta-blocker) and verapamil (a calcium-channel blocker) reduced blood pressure in elderly patients, only verapamil also reduced ventricular mass. Other studies have found that other factors besides blood pressure reduction appear to affect ventricular mass reduction. The possible benefits of high blood pressure therapy that extend beyond the primary goal of treatment are not known. Large, controlled clinical trials are needed to realistically answer this and other questions. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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A polymorphism of a platelet glycoprotein receptor as an inherited risk factor for coronary thrombosis

Article Abstract:

Relatively young people may develop unstable heart disease via a genetically inherited risk factor, the PlA2 polymorphism of the glycoprotein IIIa gene. Heart attacks and unstable angina are a result of platelet formation at the glycoprotein receptor IIb/IIIa of a ruptured arteriosclerotic plaque. Using two analytical methods, researchers compared the PlA2 configuration of 71 heart patients to 68 other patients without known heart disease (the control group). Compared to the control group, patients with heart attacks or unstable angina were much more likely to have the PlA2 allele, especially those under 60 years old. Among these younger patients, 50% had evidence of at least one PlA2 allele, compared to a prevalence of 13.9% among controls. The chance of having a heart complication before the age of 60 years was at least six times higher in the presence of this genetic configuration.

Health aspects, Risk factors, Physiological aspects, Coronary heart disease, Glycoproteins, Genetic polymorphisms, Blood platelets, Platelet-derived growth factor receptors

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