Cardiac and Hemodynamic Adjustments to Rapid and Sustained Blood Pressure Reduction

With the increasingly widespread recognition of the adverse side effects of traditional antihypertensive medications, alternative approaches to the treatment of uncomplicated hypertensive patients have been proposed. The use of vasodilator agents, calcium-channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and α-adrenergic receptor blockers results in blood pressure reduction without adverse metabolic consequences. Furthermore, vasodilatory agents reverse the principal physiological abnormality of hypertensive patients, that is, they reverse the increased systemic vascular resistance that characterizes these patients and, in so doing, may alleviate abnormalities of systolic and diastolic left ventricular performance. In particular, a comparison of the effects of nifedipine and propranolol on left ventricular (LV) function in patients with moderately severe hypertension revealed significant differences in their effects on cardiac function. Although both drugs reduced blood pressure to an identical degree, nifedipine therapy was associated with a decrease in systemic vascular resistance, an increase in cardiac output, and improved parameters of left ventricular contractile and diastolic function as measured by quantitative radionuclide ventriculography. Vasodilator therapy should be considered for the initial treatment of patients with uncomplicated essential hypertension. Am J Hypertens 1989;2:200S–206S