Normalization of left ventricular mass and associated changes in neurohormones and atrial natriuretic peptide after 1 year of sustained nifedipine therapy for severe hypertension

Sixteen patients with severe hypertension were treated for 1 year with extended release nifedipine, during which time serial changes in left ventricular mass index and associated alterations in left ventricular systolic function, left ventricular filling, plasma renin activity, atrial natriuretic peptide and catecholamines were evaluated. Mean seated blood pressure (± SE) was significantly reduced from 200 ± 8/122 ± 3 to 144 ± 5/89 ± 2 mm Hg (p < 0.0001) at 1 year. After 6 months, left ventricular mass index was significantly reduced by 19% from 121 ± 8 to 96 ± 7 g/m² and this reduction was sustained at 1 year. Septal and posterior wall thickness were reduced from 13.4 ± 0.1 to 11.2 ± 0.04 mm and from 12.8 ± 0.1 to 10.0 ± 0.03 mm (p < 0.001), respectively. The prevalence of left ventricular hypertrophy decreased from 63% to 25%. Left ventricular fractional shortening increased from 34 ± 2% to 41 ± 3% (p < 0.05) and the relation between fractional shortening and end-systolic stress did not change. Over the year of sustained blood pressure reduction, the peak velocity of early filling increased from 57 ± 3 to 63 ± 4 cm/s (p = 0.07), peak velocity of late filling did not change and the ratio of late to early peak left ventricular filling velocity significantly decreased (p < 0.05). Plasma atrial natriuretic peptide levels, markedly elevated at entry, decreased from 70 ± 15 to 41 ± 8 pg/ml at 1 year (p < 0.05). Plasma renin activity and catecholamine levels were not altered. It is concluded that treatment of severe hypertension with extended release nifedipine for 1 year is accompanied by left ventricular mass regression, maintenance of left ventricular systolic function, reduction in atrial natriuretic peptide level and no detectable activation of either the sympathetic or the renin system.