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Original Article

Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular Mass

An Anglo-Scandinavian Cardiac Outcomes Trial Substudy

Anthony 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, Jamil Mayet
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https://doi.org/10.1161/HYPERTENSIONAHA.113.01360
Hypertension. 2013;HYPERTENSIONAHA.113.01360
Originally published November 11, 2013
Anthony J. Barron
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Alun D. Hughes
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Andrew Sharp
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Arun J. Baksi
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Praveen Surendran
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Richard J. Jabbour
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Alice Stanton
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Neil Poulter
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Des Fitzgerald
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Peter Sever
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Eoin O’Brien
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Simon Thom
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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Jamil Mayet
From the International Centre for Circulatory Health, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (A.J.B., A.D.H., A. Sharp, A.J.B., N.P., P. Sever, S.T., J.M., R.J.J.); Shields Lab, Complex and Adaptive Systems Laboratory, School of Medicine and Medical Sciences (P. Surendran) and The Conway Institute (D.F., E.O.), University College Dublin, Dublin, Ireland; and Molecular and Cellular Therapeutics, RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland (A. Stanton).
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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.

  • calcium-channel blockers
  • echocardiography, Doppler
  • hypertension
  • hypertrophy, left ventricular
  • 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 Mass
    Anthony 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 Mayet
    Hypertension. 2013;HYPERTENSIONAHA.113.01360, originally published November 11, 2013
    https://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 Mass
    Anthony 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 Mayet
    Hypertension. 2013;HYPERTENSIONAHA.113.01360, originally published November 11, 2013
    https://doi.org/10.1161/HYPERTENSIONAHA.113.01360
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