Left ventricular filling pattern in hypertensive patients after reversal of myocardial hypertrophy

After treatment with alpha-methyldopa a regression of left ventricular hypertrophy, due to hypertension, has been reported in spontaneously hypertensive rats. The reduction of left ventricular mass has been associated with an increase in hydroxyproline concentration, suggesting secondary functional changes. On this basis, 12 patients with essential hypertension and echocardiographic evidence of left ventricular hypertrophy have been studied before and after a 6-month alpha-methyldopa treatment. Ten normal subjects were used as a control group. Curves of changes in left ventricular diameter and velocity curves were obtained by digitation of the M-mode endocardial echoes and the diastolic patterns were studied. Before treatment all patients, as compared to normal subjects, showed: (a) prolongation of the isovolumetric relaxation time index, with increased diameter changes; (b) reduction of diameter changes and peak velocity during the rapid filling; and (c) marked compensatory increase of diameter changes and peak velocity of the filling due to atrial systole. Left ventricular hypertrophy was reduced in 5 patients (first group) after treatment. This group showed: (a) normalization of the isovolumetric relaxation time index; (b) slight increase of diameter changes during rapid filling; (c) increased peak velocity of the rapid filling; and (d) reduction of diameter changes and peak velocity during atrial systole. No changes of functional data were observed in the other 7 patients (second group) in whom left ventricular hypertrophy was unchanged after treatment. It is shown how the reduction of left ventricular hypertrophy, per se, could induce such an improvement of diastolic function, despite the biochemical changes probably caused by administration of alpha-methyldopa.