Summary
To evaluate the left ventricular functional changes induced by acute decreases in blood pressure in 15 patients with systemic hypertension and left ventricular hypertrophy, this study used Doppler and M-mode echocardiographic derived left ventricular indices. After 30 minutes of administration of sublingual nifedipine, both systolic and diastolic blood pressure decreased and heart rates increased. The left ventricular end-systolic dimension decreased but not the end-diastolic dimension, which suggests that sublingual nifedipine may decrease only afterload, not preload. Total peripheral resistance decreased from 2770 to 1960 dyne · sec · cm−5. The M-mode-derived peak rate of dimension changes improved both the systolic and diastolic phase, and Dopplerderived indices of atrial contribution to ventricular filling decreased. Because both the systolic and diastolic phase indices of LV function are sensitive to variations in both preload and afterload, the improvement of myocardial contractility per se cannot necessarily be attributed to the direct effect of the drug to myocardium. Though favorable effect of myocardial oxygen supply-demand ratio or increased adrenergic tone stimulated by the decline in systemic arterial pressures may contribute to the augmentation of LV systolic and diastolic function observed after nifedipine in the present study, the apparent augmentation of LV function appears to be attributable primarily to afterload reduction.
Similar content being viewed by others
References
Ludbrook PA, Tiefenbrum AJ, Reed FR, Sobel BE. Acute hemodynamic responses to sublingual nifedipine: Dependence on left ventricular function.Circulation 1982;65:489–497.
Sahn DJ, DeMaria A, Kisslo J, Weyman A. The Committee on M-mode Standardization of the American Society of Echocardiography. Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements.Circulation 1978;58: 1072–1083.
Teichholz LE, Kreulen T, Herman M, Gorlin R. Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence or absence of asynergy.Am J Cardiol 1976;37:7–14.
Papademetriou V, Gottdiener JS, Fletcher RD, Freis ED. Echocardiographic assessment by computer-assisted analysis of diastolic left ventricular function and hypertrophy in borderline or mild systemic hypertension.Am J Cardiol 1985;37:7–11.
Snider RA, Gidding SS, Rocchini AP, et al. Doppler evaluation of left ventricular diastolic filling in children with systemic hypertension.Am J Cardiol 1985;56:921–926.
Klein W, Brandt D, Vrecko K, Harringer M. Role of calcium antagonists in the treatment of essential hypertension.Circ Res 1983;52(Suppl 1):174–181.
Massie BM, Hirsch AT, Inouye IK, Tubau JF. Calcium channel blockers as antihypertensive agents.Am J Med 1984;77(Suppl 4A):135–142.
Kurnik PB, Tiefenbrum AJ, Ludbrook PA. The dependence of the cardiac effects of nifedipine on the responses of the peripheral vascular system.Circulation 1984;69:963–972.
Kurnik PB, Courtois MR, Ludbrook PA. Effects of nifedipine on intrinsic myocardial stiffness in man.Circulation 1986;74:126–134.
Ishida Y, Meisner, J, Tsujioka K, et al. Left ventricular filing dynamics: Influence of left ventricular relaxation and left atrial pressure.Circulation 1986;74:187–196.
Iwase M, Sotobata I, Takagi S, et al. Effects of diltiazem on left ventricular diastolic behavior in patients with hypertrophic cardiomyopathy: Evaluation with exercise pulsed Doppler echocardiography.J Am Coll Cardiol 1987;9:1099–1105.
Choong CY, Abascal VM, Thomas JD et al. Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography.Circulation 1988;78:672–83.
Klein AL, Hatle LK, Burstow DJ, et al. Doppler characterization of left ventricular diastolic function in cardiac amyloidosis.J Am Coll Cardiol 1989;13:1017–1026.
Stoddard MF, Pearson AC, Kern MJ, et al. Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans.Circulation 1989;79:1226–1236.
Lew WYW. Evaluation of left ventricular diastolic function.Circulation 1989;79:1393–1397.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hayashi, H., Iwase, M., Aoki, T. et al. Assessment of left ventricular function after sublingual administration of nifedipine in patients with moderate to severe hypertension. Cardiovasc Drug Ther 4 (Suppl 5), 969–975 (1990). https://doi.org/10.1007/BF02018302
Issue Date:
DOI: https://doi.org/10.1007/BF02018302