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      Left Ventricular Diastolic Filling Improvement Obtained by Intravenous Verapamil in Mild to Moderate Essential Hypertension: A Complex Effect

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          Abstract

          In order to try and evaluate through what prevailing mechanism verapamil (V) can induce an improvement in left ventricular (LV) diastolic early filling in mild to moderate essential hypertension, 43 properly classified essential hypertensives, aged 41-74 years (mean age 58.1 ± 10.3), and 20 age-matched normotensives were studied. All subjects underwent both echocardiographic evaluation and <sup>99m</sup>Tc radionuclide angiocardiography in basal conditions between 8.00 a.m. and noon, after an overnight rest. In essential hypertensives gated equilibrium angiocardiography was repeated 3 and 30 min after i.v. V (0.1-mg/kg bolus, followed by 0.005 mg/kg/min for the period of radionuclide data acquisition). Simultaneously, supine arterial pressure was measured with a cuff manometer. In 36 essential hypertensives a phono-echo evaluation was obtained, both at 3 and 30 min after V, deriving a LV isovolumetric relaxation index (IRTI). Among diastolic early filling indices, we particularly considered the ratio of peak filling rate (PFR) to peak ejection rate (PER) in order to take into account the interaction of systolic performance with LV relaxation and diastolic early filling. Three minutes after V the increase in PFR (from 2.47 ± 0.5 to 3.04 ± 0.8 EDV/s, p < 0.001) and the upwards tendency of PFR/PER were coupled with the enhancement in ejection fraction (from 61.1 ± 13.3 to 63.9 ± 13.8%, p < 0.001) and heart rate (from 70.3 ± 12.6 to 77.7 ± 12.2 b/min, p < 0.001) and with the reduction in mean arterial pressure (from 122 ± 16 to 107 ± 14 mm Hg, p < 0.001), systemic arterial resistance index (from 3,234 ± 968 to 2,432 ± 678 dyn s cm<sup>-5</sup> m<sup>2</sup>, p < 0.001) and end-systolic volume index (from 32.9 ± 17.1 to 31.5 ± 18.3 ml/m2, p < 0.02). On the contrary, 30 min after V, when systolic indices, heart rate, mean arterial pressure and systemic arterial resistance index had returned towards baseline values, PFR/PER showed a persistent improvement when compared with basal values (0.71 ± 0.12 vs. 0.63 ± 0.08, p < 0.005). No changes were observed in LV volumes and IRTI, either at 3 or 30 min. Moreover, also the pulmonary blood volume ratio was unchanged. A weak negative correlation was found between Δ% of IRTI and Δ% of PFR/PER 30 min after drug administration (r = 0.58, p < 0.05). Finally, essential hypertensives with increased LV LV Filling after i.v. Verapamil in Essential Hypertension mass and LV concentric hypertrophy showed a greater improvement in PFR/PER (from 0.66 ± 0.1 to 0.76 ± 0.2 and from 0.67 ± 0.1 to 0.77 ± 0.1, p < 0.005 for both). Our data indicate that the improvement in LV diastolic early filling in mild to moderate essential hypertension can be ascribed not only to the hemodynamic effect of the drug, but also to a primary influence on the functional abnormalities of the myocardial cells.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1989
          1989
          11 November 2008
          : 76
          : 1
          : 32-41
          Affiliations
          aSecond Department of Special Medical Pathology, Second Institute of Clinical Medicine, bDepartment of Clinical Pathophysiology, Nuclear Medicine Unit, University of Florence, Italy
          Article
          174469 Cardiology 1989;76:32–41
          10.1159/000174469
          2706643
          © 1989 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 10
          Categories
          Original Paper

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