The effects of quinapril on left ventricular hypertrophy, diastolic functions and plasma TIMP-1 levels in hypertensive patients

X-SUMMARYTHE EFFECTS OF QUINAPRIL ON LEFT VENTRICULAR HYPERTROPHY,DIASTOLIC FUNCTIONS AND PLASMA TIMP-1 LEVELS IN HYPERTENSIVEPATIENTSPurpose: Hypertension and left ventricular diastolic disfunction (LVDD) predispose tofibrosis in cardiac extracellular matrix. Plasma level of tissue inhibitor of metalloproteiasetype-1 (TIMP-1) was shown to be correlated with the extend of extracellular fibrosis. It isknown that antihypertensive therapy, especially renin-angiotensin-aldosterone system(RAAS) blockers, leads to regression in both LV hypertrophy (LVH) and LVDD. In thisstudy we investigate the effects of quinapril on TIMP-1 levels, LVH and LV diastolicfunctions in patients with hypertension and LVDD.Method: A total of 30 hypertensive patients with LVH and LVDD (14 male, 16 female,mean age 64,3±8,5) were enrolled to this study. The patients were consisted of those whowere not on an ACE inhibitor therapy for at least three months. The initial dose of quinaprilwas 20 mg /day in all patients. In case of insufficient blood pressure control, first quinaprildose was increased to 40 mg / day then a diuretic (12,5 mg /day hydrochlorothiazide) wasadded. Before initiation of therapy LV end diastolic diameter (LVEDD), interventricularseptum(IVS) thickness, LV posterior wall (LVPW) tickness were measured bytransthorasic echocardiography (TTE) and LV mass index (LVMI) were calculated in allpatients. Additionally transmitral pulse wave (PW) Doppler velocities of E and A waves,isovolumetric relaxation time (IVRT) and deceleration time (DT) of E wave were recorded.By tissue Doppler imaging (TDI), Em and Am waves? velocities were measured, E/A andEm/Am ratios were calculated. TIMP-1 plasma levels were studied by ELISA method.After six months of quinapril therapy, LVMI, LV diastolic functions and plasma TIMP-1levels were reevaluated.Results: After six months of therapy there was a significant decrease in systolic anddiastolic blood pressure (p<0,0001, p<0,0001 respectively ). TIMP-1 levels and LVMIwere also significantly lower then the initial values at the end of this six months (p<0,0001,38p<0,0001 respectively). In TDI there was no change in lateral Em/Am ratio (p=0,54),whereas septal Em/Am ratio was significantly higher (p=0,003) at the end of the therapy.There was a trend of increased E/A ratio by conventional Doppler measurement but thiswasn?t significant (p=0,076). IVRT values did not change significantly by the end of thissix months therapy (p=0,68). DT was significantly decreaed with therapy (p=0,017). Therewas a negative correlation between the decrease in TIMP-1 and decrease in LVMI (R=-0,444, p=0,014). No significant correlation was found betweeen TIMP-1 change andsystolic and diastolic blood pressures changes (p=0,508, p=0,583 respectively). Neither acorrelation was found between TIMP-1 and DT (p=0,985) nor with Em/Am (p=0,766).Conclusions: TIMP-1 levels in hypertensive patients with LVH and LVDD were found tobe higher than the levels of normal population. Antihypertensive treatment with quinaprilresulted in a decrease in systolic and diastolic blood pressures, as well in TIMP-1 levelsand LVMI. Some of the LV diastolic function parameters were found to be improved byquinapril therapy. DT and septal Em/Am ratio were significantly increased. There was alsononsignificant increase PW Doppler E/A ratio. The decrease in TIMP-1 level was notfound to be correlated with the change in blood pressure and diastolic function parameters.There was a negative correlation between the changes in TIMP-1 and LVMI.39