Assessment of arterial ventricular coupling changes in patients under therapy with various antihypertensive agents by a non-invasive echocardiographic method

Background: The integration between arterial and ventricular function has been studied by mostly invasive techniques. We considered assessing the influence of various antihypertensive medications on arterial–ventricular coupling (AVC) with the use of a non-invasive echocardiographic method. Methods: A total of 9037 patients, who had been under treatment for essential arterial hypertension were studied echocardiographically at baseline prior to therapy and after 6 months of antihypertensive monotherapy (diuretics, β-blockers without intrinsic sympathomimetic activity (ISA), β-blockers with ISA, a-blockers, angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (AIIRA), non-dihydropyridine calcium antagonists, and dihydropyridine calcium antagonists). The AVC was calculated by echocardiographic measurements based on the equation: AVC=ESV/SV (ESV, end systolic volume; SV, stroke volume). Results: ACEI, AIIRA, and dihydropyridine calcium antagonists decreased (P<0.0001 for all) while diuretics, α-blockers, both β-blocker groups, and non-dihydropyridines increased significantly the AVC values compared to baseline measurements (P<0.0001 for all, except P=0.02 for α-blockers). Changes in AVC were the most highly correlated with changes in EF (r=−0.979, P<0.0001). Conclusion: Various antihypertensive drugs have a differential effect on AVC with ACEI, AIIRA, and dihydropyridine calcium antagonists having the most favorable effect on this index. AVC provides a meaningful index of cardiovascular performance in hypertension and offers the possibility of wide employment and serial follow-up in large numbers of patients because of its completely non-invasive nature.