Document Detail

Reverse remodeling and improved function by antihypertensive treatment in hypertensive patients with coronary artery disease.
MedLine Citation:
PMID:  19927011     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although antihypertensive therapy reduces cardiovascular events, it is unclear whether there are differences in cardiac remodeling and function between treatments with nifedipine retard and angiotensin-converting enzyme inhibitors (ACE-Is). It is also not clear how antihypertensive therapy influences cardiac remodeling and function. METHODS: Hypertensive patients with coronary artery disease were randomly assigned to the nifedipine retard (n = 108) or ACE inhibitors groups (n = 102) and treated for 3 years. The primary endpoints were changes in end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) as indices of cardiac remodeling, whereas the secondary endpoints were changes in ejection fraction (EF), stroke volume index (SVI), cardiac index (CI) and regional wall motion as indices of cardiac function. Left ventriculography was performed at baseline and after 3 years of treatment. Fifty-eight and 61 patients, respectively, were subjected to the final analysis. RESULTS: Comparable changes in remodeling and function were obtained in the nifedipine retard group and the ACE-Is group. Both groups showed a significant reduction of EDVI and ESVI, and a significant increase in EF, SVI, and CI, whereas the decreased regional wall motion significantly improved. In both groups, weak but significant correlations were noted between treatment-induced changes of systolic blood pressure and those of primary and secondary endpoints. CONCLUSION: The above findings show that treatments with nifedipine retard or ACE-Is cause a comparable change in remodeling and cardiac function. Lowering of the blood pressure by either drug leads to reverse remodeling or improvement of cardiac function. In addition to alleviation of coronary artery damage by reducing blood pressure, there is a favorable effect on the left ventricular structure and function. Reducing the blood pressure is critically important for hypertensive patients with coronary artery disease.
Yoshiki Yui; Kazuhisa Kodama; Atsushi Hirayama; Ryosuke Nishio; Yoshitaka Iwanaga; Hiroshi Nonogi; Kazuo Haze; Tetsuya Sumiyoshi; Natsuko Yui; Saichi Hosoda; Chuichi Kawai;
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  28     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-17     Completed Date:  2010-03-09     Revised Date:  2010-05-10    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  178-85     Citation Subset:  IM    
Department of Cardiovascular Medicine, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects,  physiology
Coronary Artery Disease / complications,  drug therapy*,  physiopathology
Heart Function Tests
Hemodynamics / drug effects,  physiology
Hypertension / complications,  drug therapy*,  physiopathology
Middle Aged
Nifedipine / therapeutic use*
Vasodilator Agents / therapeutic use*
Ventricular Remodeling / drug effects*
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Vasodilator Agents; 21829-25-4/Nifedipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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