Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular Mass
An Anglo-Scandinavian Cardiac Outcomes Trial Substudy

Abstract
Antihypertensive treatment can improve tissue Doppler indices of left ventricular diastolic function in the short term, but little is known about the longer-term effect of different antihypertensive treatments on progression of left ventricular diastolic function and left ventricular hypertrophy. We hypothesized that long-term treatment of hypertension will lead to improvements in left ventricular hypertrophy and diastolic function. We collected detailed cardiovascular phenotypic data on 1006 participants from a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial. Patients randomized to either an amlodipine±perindopril-based or an atenolol±bendroflumethiazide-based regimen underwent conventional and tissue Doppler echocardiography at time of control of blood pressure after randomization (≈1.5 years; phase 1) and after a further 2 years of antihypertensive treatment (phase 2). There were no prerandomization data. Five hundred thirty-six patients had complete data collection at both phases. Left ventricular mass index regressed from phase 1 to 2 with no significant difference between treatment groups (amlodipine: 119.5–116.8; atenolol: 122.9–117.5; P<0.001 for both). Conversely, tissue Doppler diastolic indices did not change in the amlodipine±perindopril-based regimen (E/e′, 7.5–7.6 cm/s; P=not significant), but deteriorated in the atenolol±bendroflumethiazide-based regimen (E/e′, 8.0–8.5 cm/s; P<0.01). Despite regression of left ventricular hypertrophy, there was no associated improvement in diastolic function. In fact, long-term treatment with atenolol±bendroflumethiazide resulted in a progressive deterioration in E/e′. This may be a factor contributing to the previously described worse clinical outcome in patients treated with atenolol±bendroflumethiazide compared with amlodipine±perindopril.
- Received March 8, 2013.
- Revision received March 29, 2013.
- Accepted October 12, 2013.
- © 2013 American Heart Association, Inc.
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- Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular MassAnthony J. Barron, Alun D. Hughes, Andrew Sharp, Arun J. Baksi, Praveen Surendran, Richard J. Jabbour, Alice Stanton, Neil Poulter, Des Fitzgerald, Peter Sever, Eoin O’Brien, Simon Thom and Jamil MayetHypertension. 2013;HYPERTENSIONAHA.113.01360, originally published November 11, 2013https://doi.org/10.1161/HYPERTENSIONAHA.113.01360
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- Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular MassAnthony J. Barron, Alun D. Hughes, Andrew Sharp, Arun J. Baksi, Praveen Surendran, Richard J. Jabbour, Alice Stanton, Neil Poulter, Des Fitzgerald, Peter Sever, Eoin O’Brien, Simon Thom and Jamil MayetHypertension. 2013;HYPERTENSIONAHA.113.01360, originally published November 11, 2013https://doi.org/10.1161/HYPERTENSIONAHA.113.01360