9.7 Improvement of Left Ventricular Circumferential Performance in Subjects with Mild-To-Moderate Hypertension After Three Months Treatment with Barnidipine
Introduction: Barnidipine is a last-generation dihydropyridinic calcium antagonist, with selected vascular action and without negative inotropic effect on LV.
Aim: to verify the effects of a medium-term treatment with Barnidipine on LV geometry and function, in patients with mild to moderate essential HBP.
Methods: 24 newly diagnosed, previously untreated high blood pressure patients [15 males, mean age 58.4±10 yrs, MBP 160±15/94±14 mmHg, BMI 26.6±4.9 kg/m2] were enrolled. Preserved LV function and absence of chest pain and inducible myocardial ischaemia were selection criteria. After two-week run-in period on placebo, Barnidipine therapy was started (10 mg o.i.d.) and titrated to 20 mg o.i.d. after 4 weeks for office BP>135/85 mmHg. Detailed cardiovascular investigation by ultrasound (Aloka SSD 5500) was planned at baseline (T0), after 3- and 6-month therapy [LV geometry, circumferential and longitudinal systolic function and diastolic filling were determined by M-mode, 2D echo, Tissue Velocity Imaging (TVI) and transmitral Doppler]. Arterial mechanics was evaluated by a new ultrasound technique capable to provide real-time arterial waveform analysis with high temporal and spatial resolution (Aloka, Tokyo, Japan). When calibrated for blood pressure (BP), arterial stiffness parameters such as stiffness index (“Beta”), pressure-strain elastic modulus (“Epsilon”) and a single point local wave speed (WS) are obtained.
Results: Five patients dropped out for inadequate BP response Data reported here refer to the first 16 patients who underwent so far the follow-up study at three months. BP decreased significantly (p<0.005) from 160±15/94±14 to 145±18/84±12 mmHg while HR did not change (68±13 vs 71±12 b/min, p=ns). LV mass index, relative wall thickness, septal and posterior wall thickness and LV diastolic diameter remained unchanged (T0 vs T3, p=ns). A significant increase in LV midwall circumferential shortening was found [absolute MWS: 19.2±2.8 vs 21.4±2.3%; stress-adjusted MWS: 114±15 vs 124±13%, p<0.02)], together with a 14% increment of cardiac index (da 3.2±0.7 a 3.6±0.8 L/min/m2, p=ns). By contrast, TVI indices of LV longitudinal function, and transmitral Doppler indices of LV diastolic filling did not show relevant changes. Augmentation index, beta stiffness index, and Peterson’s elastic modulus were reduced by 10–15% (T3 vs T0 p=n.s.).
Conclusions: A 3-month therapy with Barnidipine in mild to moderate HBP is associated with improvement in circumferential LV systolic shortening, associated with mild increment in LV pump function and large artery distensibility. These changes are in keeping with vasodilator properties of the drug without direct myocardial effects.
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Morizzo, C., Malshi, E., Kozàkovà, M. et al. 9.7 Improvement of Left Ventricular Circumferential Performance in Subjects with Mild-To-Moderate Hypertension After Three Months Treatment with Barnidipine. High Blood Press Cardiovasc Prev 14, 145 (2007). https://doi.org/10.2165/00151642-200714030-00160