Long-term and strict blood pressure lowering by imidapril reverses left ventricular hypertrophy in patients with essential hypertension: an evaluation using a novel indicator of burden on the left ventricle.

Left ventricular hypertrophy is an independent risk factor for cardiovascular disease. We evaluated the effect of long-term and strict antihypertensive therapy with and without the angiotensin-converting enzyme inhibitor (ACEI) imidapril on left ventricular hypertrophy using a novel indicator of chronic burden on the left ventricle, the area under the blood pressure curve x the duration of high blood pressure (AUSBP and AUDBP), in patients with essential hypertension. The patients were divided into 2 groups: an ACEI group, in which imidapril was used in addition to antihypertensive drugs such as Ca channel blockers, beta-blockers, diuretics or angiotensin II antagonist; and a non-ACEI group, in which Ca channel blockers and diuretics were used. Systolic and diastolic blood pressures (SBP and DBP) were both maintained at below 140 and 90 mmHg, respectively, for 2 years. There was no significant difference in the left ventricular mass (LVM) assessed by echocardiography at baseline and that at 2 years of follow-up in the non-ACEI group. However, the LVM in the ACEI group was significantly decreased at 2 years of follow-up as compared to that at the baseline visit. There was no difference in the mean AUSBP and AUDBP between the ACEI and non-ACEI groups. Changes in the LVM were not correlated with the AUSBP or AUDBP in both the ACEI and non-ACEI groups. These findings suggest that the decrease in the LVM in the ACEI group was mediated through mechanisms other than the blood pressure lowering-effect and that AUSBP and AUDBP may be novel indicators of the long-term burden on the left ventricle.