Regression of Left Ventricular Hypertrophy and Improvement of Diastolic Function in Hypertensive Patients Treated with Telmisartan

Objectives: The study was designed to test whether or not the angiotensin II receptor blocker telmisartan brings about regression of left ventricular (LV) concentric hypertrophy and whether or not these changes are associated with improved diastolic filling. Methods: An echocardiographic follow-up study was performed in 85 hypertensive patients (systolic blood pressure [SBP] >140 mm Hg, diastolic blood pressure [DBP] >90 mm Hg) and mild-to-moderate LV hypertrophy (LV mass index related to body surface area [LVMI] 117–150 g/m2 for men and 105–150 g/m2 for women) treated with telmisartan monotherapy 40–80 mg once daily for 1 year. Blood pressure, LVMI, left atrial (LA) volumes, and diastolic function were determined at baseline and after 3, 6, 9, and 12 months of treatment. Blood pressure was also monitored at all visits. Diastolic function was assessed by examination of transmitral inflow and pulmonary vein flow patterns. Results:Telmisartan reduced blood pressure; after 12 months, the mean FS.D. SBP and DBP were reduced from 144F10 to 126F8 mm Hg (p < 0.001) and from 98F8 to 86F7 mm Hg ( p < 0.001), respectively. The LVMI was decreased from 119F7 to 109F3 g/m2 (p < 0.001) after 12 months’ telmisartan treatment. All patients had diastolic dysfunction at baseline. After 12 months’ telmisartan treatment, a normal pattern of transmitral inflow was present in 21% of patients. The regression of LV hypertrophy observed after 12 months was associated with increased peak early diastolic velocity/peak late diastolic velocity ratio from 0.60F0.18 to 0.83F0.20 ( p < 0.001), shortened isovolumicrelaxation time (IVRT) from 110F13 to 105F13 ms ( p < 0.001), and decreased deceleration time from 229F30 to 215F28 ms( p = 0.002). Univariate analysis showed that shortened IVRT was related to a reduction in the LVMI and LA maximal and minimal volumes.In the multivariate analysis, the reduction in LVMI and the reduction in LA maximal and minimal volumes were independently associated with IVRT reduction. Conclusions: Telmisartan 40–80 mg is effective in LV hypertrophy regression in hypertensive patients. The reduction in LVMI due to telmisartan monotherapy was associated with a significant improvement of diastolic filling parameters and with a significant reduction of LA volumes.