Effect of nifedipine GITS on left ventricular mass and diastolic function in severe hypertension

Treatment of severe hypertension is beneficial, but reversibility of target-organ damage has not been characterized. Serial studies were performed in 15 patients with severe essential hypertension (age of 56 ± 3 years, mean ± SEM) treated for 1 year with 60 to 150 mg/day of continuous-release nifedipine; 3 patients required 50 mg of chlorthalidone/day to lower diastolic blood pressure (BP) to <95 mm Hg. Left ventricular (LV) structure and function was evaluated with two-dimensional-directed M-mode echocardiography, digitized from videotape and analyzed blindly. BP was markedly reduced from 194 ± 8/115 ± 4 to 146 ± 4/88 ± 14 mm Hg (p < 0.0001) and maintained at this level for 1 year. Posterior wall and septal LV thickness, elevated at entry (12.9 ± 0.1 and 13.4 ± 0.1 mm), dropped steadily over 1 year into the normal range (10.0 ± 0.03 and 11.2 ± 0.1 mm, p < 0.001). LV mass index, above 95% for normals at entry, decreased by 19% at 6 months (129 ± 10 to 104 ± 7 g/m², p < 0.01), and remained at this level at 1 year. LV fractional shortening rose steadily over 1 year from 34 to 42% (p < 0.02). Atrial natriuretic peptide, which reflects LV filling pressures, was markedly elevated at entry, but was significantly reduced by 6 months (76 ± 22 vs. 45 ± 14 pg/ml, p < 0.05). Sustained reduction of arterial BP with continuous-release nifedipine for 1 year normalizes LV mass, improves LV systolic function, and reduces circulating levels of atrial natriuretic peptide.