佐々木 美和, 大木 崇, 井内 新, 田畑 智継, 伊東 進

Miwa SASAKI, Takashi OKI, Arata IUCHI, Tomotsugu TABATA, Susumu ITO

徳島大学第2内科

Second Department of Internal Medicine Tokushima University School of Medicine

キーワード : ACE inhibitor, Hypertension, LV diastolic dysfunction

To assess the effects of angiotensin converting enzyme (ACE) inhibitor on left ventricular (LV) hypertrophy and diastolic dysfunction, M-mode and pulsed Doppler echocardiographic variables were compared before and after 6 months of treatment with enalapril in 50 patients with essential hypertension (19 patients who had both LV hypertrophy and diastolic dysfunction and 31 who did not have LV hypertrophy but had diastolic dysfunction) and 15 patients who and LV diastolic dysfunction but did not have hypertension. After enalapril was administered: (1) mean blood pressure decreased significantly in all hypertensive patients, but remained unchanged in patients without hypertension; (2) LV mass index decreased significantly in all hypertensive patients but did not change in patients without hypertension; (3) ratio (A/E) of the peak velocity of the atrial systolic wave (A) to that of the early diastolic wave (E) in transmitral flow velocity, deceleration time (E-DT) from the peak to baseline of the E wave, and isovolumic relaxation time (IRT) from the aortic component of the second heart sound on the phonocardiogram to the onset of the E wave decreased significantly in all patients, regardless of their blood pressure; (4) decreasing rate of A/E and duration of hypertension correlated closely; and (5) LV mass index, A/E, and IRT decreased more after administration of enalapril to patients with the DD genotype of ACE gene than to those with the ID and II genotypes. These results suggest that treatment of hypertension by long-term administration of enalapril improves LV diastolic hemodynamics regardless of the presence or absence of LV hypertrophy, and, further, that the effects are greater in patients with a shorter duration fo hypertension and in those the with DD genotype of ACE gene.