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Dias IARB, Costa WM, Cervini P, Cavalheiro ETG, Marques ALB. Ruthenium Hexacyanoferrate (III) Modified Glassy Carbon Electrode for Determination of Captopril. ELECTROANAL 2016. [DOI: 10.1002/elan.201600107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- I. A. R. B. Dias
- CCET/NEPE-LPQA; Universidade Federal do Maranhão; Av. dos Portugueses, SNP CEP 65.080-040 São Luís - MA Brasil
| | - W. M. Costa
- CCET/NEPE-LPQA; Universidade Federal do Maranhão; Av. dos Portugueses, SNP CEP 65.080-040 São Luís - MA Brasil
| | - P. Cervini
- Departamento de Química e Física Molecular; Instituto de Química de São Carlos; Av. Trabalhador São-Carlense, 400, Centro São Carlos, São Paulo CEP 13566-590 Brazil
| | - E. T. G. Cavalheiro
- Departamento de Química e Física Molecular; Instituto de Química de São Carlos; Av. Trabalhador São-Carlense, 400, Centro São Carlos, São Paulo CEP 13566-590 Brazil
| | - A. L. B. Marques
- CCET/NEPE-LPQA; Universidade Federal do Maranhão; Av. dos Portugueses, SNP CEP 65.080-040 São Luís - MA Brasil
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2
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Risk Factor-induced Cardiovascular Remodeling and the Effects of Angiotensin-Converting Enzyme Inhibitors. J Cardiovasc Pharmacol 2008; 51:523-31. [DOI: 10.1097/fjc.0b013e31817751a7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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3
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Abstract
Approximately 5 million people in the United States have heart failure. Epidemiologic studies have demonstrated that at least one half of patients who have clinically overt heart failure have diastolic heart failure (DHF), or heart failure with preserved ejection fraction. DHF is characterized by concentric remodeling with normal left ventricular end-diastolic volume, abnormalities of active relaxation, and increased passive ventricular stiffness. Diuretics are an essential component of therapy for most patients who have DHF, and treatment of hypertension is a cornerstone of therapy designed to prevent or to treat DHF. Several antihypertensive agents have been shown to effectively reduce wave reflection, including angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium antagonists, and nitrates. Lifestyle changes may also be helpful.
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Affiliation(s)
- Dinko Susic
- Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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4
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Chiu CZ, Cheng JJ. Congestive Heart Failure in the Elderly. INT J GERONTOL 2007. [DOI: 10.1016/s1873-9598(08)70038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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5
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Abstract
Most elderly patients, particularly women, who have heart failure have a normal ejection fraction. Patients who have this syndrome have severe symptoms of exercise intolerance, frequent hospitalizations, and increased mortality. The pathophysiology and treatment are not well defined. Control of systemic hypertension may be a key to prevention and treatment. Several large trials of specific agents are currently underway.
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Affiliation(s)
- Dalane W Kitzman
- Wake Forest University Health Sciences Center, Winston-Salem, NC, USA.
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6
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Abstract
Most elderly patients, particularly women, who have heart failure have a normal ejection fraction. Patients who have this syndrome have severe symptoms of exercise intolerance, frequent hospitalizations, and increased mortality. The pathophysiology and treatment are not well defined. Control of systemic hypertension may be a key to prevention and treatment. Several large trials of specific agents are currently underway.
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Affiliation(s)
- Dalane W Kitzman
- Department of Internal Medicine, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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7
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Egi M, Bellomo R, Langenberg C, Haase M, Haase A, Doolan L, Matalanis G, Seevenayagam S, Buxton B. Selecting a Vasopressor Drug for Vasoplegic Shock After Adult Cardiac Surgery: A Systematic Literature Review. Ann Thorac Surg 2007; 83:715-23. [PMID: 17258030 DOI: 10.1016/j.athoracsur.2006.08.041] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 08/22/2006] [Accepted: 08/23/2006] [Indexed: 11/30/2022]
Abstract
The choice of vasopressors to treat vasodilatory shock after cardiac surgery is a matter of controversy. We have systematically reviewed the literature and found that the data are insufficient to guide choice of agent. However, we found sufficient evidence that when a target blood pressure can not be achieved with a single agent, addition of another is more likely to help achieve the blood pressure target. We also found that there is no evidence that vasopressors induce organ ischemia. Finally, the lack of high quality data indicate that large multicenter trials are needed in this field.
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Affiliation(s)
- Moritoki Egi
- Department of Intensive Care and Medicine, University of Melbourne, Austin Hospital, Heidelberg Victoria, Australia
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8
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White SE. Anesthesiology: perioperative medicine or "when the anesthetic is a diuretic". J Clin Anesth 2004; 16:130-7. [PMID: 15110377 DOI: 10.1016/j.jclinane.2003.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Accepted: 08/07/2003] [Indexed: 10/26/2022]
Abstract
Two patients are reported, each with heart failure, who were treated with digoxin (case 1) and furosemide (case 2). Indications for medical treatment of patients with heart failure, the role of various drugs, and exercise therapy, are reviewed. At a time when the population of people over 65 years of age is increasing, it is important for physicians to recognize the symptoms of heart failure and to know the most up-to-date treatment for this disorder. These cases demonstrate the significance of the anesthesiologist as a perioperative physician.
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Affiliation(s)
- Sno E White
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-254, USA
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Bennett SR, McKeown J, Drew P, Griffin S. Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors. Eur J Heart Fail 2001; 3:587-92. [PMID: 11595607 DOI: 10.1016/s1388-9842(01)00155-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Patients presenting for cardiac surgery are often treated with angiotensin converting enzyme inhibitors (ACEIs), either for heart failure or hypertension. Control of systemic vascular resistance (SVR) during surgery can be difficult in such patients. Angiotensin II has been available as an unlicensed vasoconstrictor, but there is concern about renal damage and its use. AIM This study compared a standard vasoconstrictor with angiotensin II and examined the effect on renal function after cardiac surgery. METHOD Twenty consecutive, consenting patients scheduled for cardiac surgery that had been taking ACEIs for at least 6 months, were randomly assigned to receive either phenylephrine or angiotensin II for the control of SVR during and for 24 h after cardiac surgery. A pulmonary artery catheter was used to guide therapy. Creatinine clearance was measured before, 24 and 48 h after surgery. RESULTS Low SVR and blood pressure requiring intervention was seen in all patients, particularly during cardiopulmonary bypass. One patient in the control group failed to respond to P, but responded normally to angiotensin II. Neither drug caused renal impairment. CONCLUSION Angiotensin II is a safe alternative to phenylephrine in patients on ACEIs and should be considered in patients who fail to respond to conventional vasoconstrictors.
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Affiliation(s)
- S R Bennett
- Department of Anaesthesia, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK.
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11
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Hoffmann U, Globits S, Stefenelli T, Loewe C, Kostner K, Frank H. The effects of ACE inhibitor therapy on left ventricular myocardial mass and diastolic filling in previously untreated hypertensive patients: a cine MRI study. J Magn Reson Imaging 2001; 14:16-22. [PMID: 11436209 DOI: 10.1002/jmri.1145] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cardiac remodeling in case of hypertension induces hypertrophy of myocytes and elevated collagen content and, subsequently, impaired diastolic filling of the left ventricle. The purpose of this prospective study was to evaluate changes of left ventricular (LV) myocardial mass, as well as diastolic filling properties, in hypertensive patients treated with the ACE inhibitor fosinopril. Sixteen hypertensive patients with echocardiographically documented LV hypertrophy and diastolic dysfunction received fosinopril (10-20 mg daily). Measurements of LV myocardial mass and properties of diastolic filling (peak filling fraction (PFF); peak filling rate (PFR)) were performed prior to medication, as well as after 3 and 6 months of therapy using cine magnetic resonance imaging (MRI). Ten healthy subjects served as a control group. LV myocardial mass (g/m2) decreased continuously within 3-6 months of follow-up by 32% (148 +/- 40 vs. 120 +/- 26 vs. 101 +/- 22 g/m2; P < 0.0001/0.005). The extent of regression correlated to the severity of LV hypertrophy at baseline (r = 0.77; P < 0.004). Early diastolic filling increased significantly within 6 months of therapy (PFF (%): 36 +/- 6 vs. 61 +/- 7, P < 0.0001; PFR (mL/second): 211 +/- 48 vs. 282 +/- 48, P < 0.001). Cine MRI can be used to assess the time course of pharmacological effects on cardiac remodeling in the course of hypertension. ACE inhibitor therapy results in a significant reduction of LV mass within 3 months and is accompanied by a normalization of diastolic filling that is completed after 6 months.
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Affiliation(s)
- U Hoffmann
- Department of Diagnostic Radiology, University Hospital of Vienna, Vienna, Austria.
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Hernández D, Lacalzada J, Salido E, Linares J, Barragán A, Lorenzo V, Higueras L, Martín B, Rodríguez A, Laynez I, González-Posada JM, Torres A. Regression of left ventricular hypertrophy by lisinopril after renal transplantation: role of ACE gene polymorphism. Kidney Int 2000; 58:889-97. [PMID: 10916115 DOI: 10.1046/j.1523-1755.2000.00239.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac complications are the main cause of death in renal transplantation (RT), and left ventricular hypertrophy (LVH) may play an important role in these patients. The unfavorable genotype of the angiotensin-converting enzyme (ACE) gene has been associated with cardiovascular disease, including LVH. ACE inhibitors (ACEIs) reduce LVH, but little is known about the effects of ACEIs on LVH in RT patients with different insertion/deletion (I/D) genotypes of the ACE gene. METHODS We prospectively studied 57 stable nondiabetic RT patients with hypertension and echocardiographic LVH as well as a functional graft for 69.5 +/- 5.6 months. Patients randomly received either lisinopril 10 mg/day (group A, N = 29; 5 were excluded due to reversible acute renal failure) or placebo (group B, N = 28) for 12 months. Echocardiography (M-mode, 2-B, and color flow Doppler) was performed at baseline and 6 and 12 months later by the same examiner without previous knowledge of the genetic typing. The ACE genotype (I or D alleles) was ascertained by polymerase chain reaction (PCR; group A, DD = 10 and ID/II = 14; group B, DD = 15 and ID/II = 13). RESULTS All patients maintained a good renal function (serum creatinine <2.5 mg/dL) during the follow-up and both groups received a similar proportion of antihypertensive drugs (beta-blockers 83 vs. 79%; Ca antagonists 66 vs. 68%; alpha1-adrenoreceptor antagonists 50 vs. 67%) during the study. As expected, mean arterial blood pressure and hemoglobin levels showed a higher percentage reduction in group A versus group B (-4 +/- 2.8 vs. 2.1 +/- 2.6%, P = 0.07, and -11.5 +/- 1.5 vs. -0.5 +/- 2.3%, P < 0.01, respectively). Group A patients showed a significantly higher decrement in LV mass index (LVMI) than group B at the end of follow-up, after adjusting for age, baseline LVMI, time after grafting and changes in systolic blood pressure, renal function, and hemoglobin levels (group A, -9.5 +/- 3.5% vs. group B, 3 +/- 3.2%, P < 0.05). As a result, 46% of group A and only 7% of group B patients showed a reduction of LVMI >/=15% (P < 0.01). The beneficial effect of lisinopril on LVMI reduction was more evident in DD patients (placebo DD, 8.4 +/- 4.1% vs. lisinopril DD, -7.2 +/- 5.3, P < 0.05), and a trend was observed in patients with other genotypes (placebo ID/II, 2.8 +/- 5.4% vs. lisinopril ID/II, -11.4 +/- 5%, P = 0.33). CONCLUSIONS Lisinopril decreases LVM in renal transplant patients with hypertension and LVH, and the ACE gene polymorphism may predict the beneficial effect of this therapy. This finding may be important in targeting prophylactic interventions in this population.
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Affiliation(s)
- D Hernández
- Nephrology and Cardiology Services, and Unidad de Investigación, Hospital Universitario de Canarias, Tenerife, Spain.
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13
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Abstract
Diastolic left ventricular function is altered substantially with advancing age in healthy persons, and diastolic dysfunction impacts most cardiovascular disorders in the elderly. Older, healthy persons have a delayed relaxation Doppler filling pattern and their early deceleration time is similar to, or modestly lengthened, compared with younger, healthy persons. Two abnormal Doppler filling patterns, the pseudo-normal and the restricted, are discerned more easily, and are more specific in the elderly than the young, because they are the opposite (reverse) of the normal elderly pattern. Most heart failure in the elderly occurs in the presence of preserved systolic function (presumed diastolic heart failure). Elderly patients with diastolic heart failure tend to be women with hypertrophied, hyperdynamic left ventricles, and chronic hypertension. Prognosis may be somewhat better than in systolic heart failure, but the difference diminishes when adjusted for gender and in the very elderly. The pathophysiology of this disorder is not well characterized, diagnostic criteria have not been standardized, and there are no large, multicenter, randomized trials to guide therapy. Further research in this area should be a high priority.
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Affiliation(s)
- D W Kitzman
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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14
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Abstract
Contrary to popular belief, population studies indicate that most elderly patients with heart failure have preserved left ventricular systolic function (i.e., presumed diastolic heart failure). Several normal aging changes may predispose older individuals to diastolic heart failure, including increased hypertrophy and stiffness of the left ventricle, increased vascular stiffness, and decreased cardiovascular reserve. Progress in diastolic heart failure has been hindered by a lack of standard case definition; absence of a readily available, reliable test to quantitate diastolic function; poor understanding of the pathophysiology of heart failure; and lack of data from randomized, controlled, multicenter trials. Typical patients are older women with chronic hypertension, left ventricular hypertrophy, chronic exercise intolerance, and occasional acute exacerbations (pulmonary edema). Although heart failure is a clinical, bedside diagnosis, echocardiography is helpful in differentiating diastolic from systolic heart failure and in ruling out other disorders. Although optimal pharmacologic therapy has not been clarified, control of blood pressure; exercise conditioning; and a multidisciplinary, case management approach seem beneficial.
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Affiliation(s)
- D W Kitzman
- Section of Cardiology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
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Higaki J, Aoki M, Morishita R, Kida I, Taniyama Y, Tomita N, Yamamoto K, Moriguchi A, Kaneda Y, Ogihara T. In vivo evidence of the importance of cardiac angiotensin-converting enzyme in the pathogenesis of cardiac hypertrophy. Arterioscler Thromb Vasc Biol 2000; 20:428-34. [PMID: 10669640 DOI: 10.1161/01.atv.20.2.428] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac angiotensin-converting enzyme (ACE) may play an important role in regulating cardiac hypertrophy. Angiotensin II (Ang II) stimulates cardiac hypertrophy as well as the production of extracellular matrix. However, it is still unclear whether Ang II exerts a direct effect on cardiac hypertrophy independent of its effect on blood pressure or the circulating renin-angiotensin system. Although ACE inhibitors and/or Ang II receptor antagonists have regressed cardiac hypertrophy, classic pharmacological experiments cannot exclude the contribution of hemodynamics and the circulating renin-angiotensin system. In vivo gene transfer provides the opportunity of assessing the effects of increased cardiac angiotensin in the intact animal without circulating angiotensin or blood pressure. Therefore, we used a "gain of function" approach to obtain local overexpression of cardiac ACE. Transfection of the human ACE vector into rat myocardium resulted in a significant increase in cardiac ACE activity (P<0.01). More interestingly, morphometry at 2 weeks after transfection revealed a significant increase in the thickness and areas of cardiac myocytes in hearts transfected with the ACE vector (P<0.01). In addition, transfection of the ACE vector also resulted in a significant increase in collagen content (P<0.01). This increase in cardiac hypertrophy was abolished by the administration of perindopril. Local transfection of the ACE vector into the heart did not result in systemic effects such as increased blood pressure, heart rate, or serum ACE activity. In summary, we have demonstrated that increased autocrine/paracrine angiotensin can directly cause cardiac hypertrophy independent of systemic factors and hemodynamic effects. This approach has important potentials for defining the role of autocrine/paracrine substances in cardiovascular disease.
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Affiliation(s)
- J Higaki
- Department of Geriatric Medicine, Osaka University Medical School, Osaka, Japan
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Sica DA, Gehr TWB, Kelleher N, Blumenthal M. Fosinopril: Emerging Considerations and Implications for Angiotensin-Converting Enzyme Inhibitor Therapy. ACTA ACUST UNITED AC 1998. [DOI: 10.1111/j.1527-3466.1998.tb00362.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Castro S, Pelliccia F, Cartoni D, Funaro S, Melillo G, Beni S, Magni G, Migliau G, Fedele F. Effects of angiotensin-converting enzyme inhibition on left ventricular geometric patterns in patients with essential hypertension. J Clin Pharmacol 1996; 36:1141-8. [PMID: 9013371 DOI: 10.1002/j.1552-4604.1996.tb04168.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although angiotensin-converting enzyme inhibitors have been shown to affect left ventricular (LV) remodeling favorably in several conditions, it remains unclear whether they can influence LV geometric pattern in hypertension. To address this issue, 122 patients (71 men and 51 women; mean age = 51 +/- 10 years) with mild to moderate hypertension were studied prospectively. All underwent clinical evaluation and Doppler echocardiography at entry and more than 2 years of quinapril therapy (10-40 mg/day). According to either LV mass (normal if < 131 g/m2 for men or < 100 g/m2 for women) or the ratio of LV posterior wall thickness to diastolic diameter (RWT; normal if < 0.45) at baseline, 58 patients had normal mass and RWT, 18 patients had concentric remodelling (i.e., normal mass but increased RWT), 24 patients had eccentric hypertrophy (i.e., increased mass but normal RWT), and 22 patients had concentric hypertrophy (i.e., increase in both mass and RWT). After 6 months of quinapril therapy, all patients with normal left ventricles showed the maintenance of mass and RWT within normal limits. Patients with concentric remodeling showed no increase in mass but had a significant decrease in RWT. Patients with eccentric hypertrophy exhibited a significant reduction in mass with no substantial change in RWT. Patients with concentric hypertrophy had a significant reduction in both mass and RWT. Changes in LV mass and geometry were maintained during the 2-year period of treatment and were paralleled by improvements in Doppler indices of LV diastolic function in each group. It is concluded that quinapril, with its well-known effects on LV hypertrophy, modifies the LV geometric pattern of hypertensive patients favorably, regardless of the presence of an abnormal LV mass or RWT.
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Affiliation(s)
- S De Castro
- Department of Clinical Medicine, La Sapienza University, Rome, Italy
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