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Long-Term Improvement of QT Dispersion is Unaffected by Short-Term Changes in Blood Pressure During Treatment of Systemic Hypertension with Enalapril

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Background: We report the reduction of QT and QTc dispersion in patients treated for 7 years with enalapril for systemic hypertension with left ventricular (LV) hypertrophy. We assess the correlation between QT dispersion and LV mass during this period and at the end of an 8-week period of suspension of enalapril treatment after 5 years.

Methods: Twenty-four previously untreated patients with this condition took enalapril (20 mg twice daily) for 7 years, except during an 8-week period following 5-year follow-up. Cardiovascular parameters were determined by two-dimensional guided M-mode echocardiography, and QT interval was measured, in a pretreatment placebo phase, 8 weeks and 1, 3, 5, and 7 years after the start of the therapy, at the end of the 8-week suspension effected after 5 years, and 8 weeks after the end of the suspension.

Results: Therapy rapidly reduced blood pressure (BP) from 156/105 mmHg to normal values: 134/84 mmHg after 8 weeks’ treatment, 130–84 mmHg at 7-year follow-up (P < 0.001 with respect to the placebo phase). LV mass index decreased progressively until at 5-year follow-up the reduction had reached 39% (P < 0.001), after which neither LV mass nor any other structural parameter underwent any further significant change. During this time, QT dispersion (ΔQT) and the dispersion of “corrected” QT (ΔQTc) decreased significantly: ΔQT (from 61 ± 21 to 37 ± 13 ms ) and ΔQTc (from 67 ± 27 to 41 ± 16 ms ). After suspension of treatment for 8 weeks following 5-year follow-up, ΔQT was 40 ± 14 ms and ΔQTc was 44 ± 17 ms ; there were no significant changes either in ΔQT and ΔQTc or LV hypertrophy although BP had returned to pretreatment values (BP: 150 ± 16; 101 ± 10 mmHg ).

Conclusions: Long-term enalapril treatment of hypertensive patients with LV hypertrophy induces marked regression of LV mass and improvement of QT dispersion. These improvements occur on a longer timescale than improvement in BP, and are not affected by transient changes in BP values.

A.N.E. 2003;8(1):47–54
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Keywords: QT dispersion; enalapril; hypertension; left ventricular mass

Document Type: Research Article

Publication date: January 1, 2003

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