Effect of regression of left ventricular hypertrophy following sotalol therapy on diastolic function in hypertensive patients.

The effects of changes in left ventricular mass following beta-adrenergic blockade therapy (sotalol) on left ventricular filling indices were examined in 16 patients with essential hypertension aged 46 +/- 8.3 years (mean +/- s.d.). The peak atrial to peak early diastolic velocity (A:E) ratio and the peak filling rate (PFR = peak early diastolic velocity X mitral annulus area) were measured by the use of pulsed Doppler left ventricular inflow time-velocity plots following placebo and after 8-12 weeks of sotalol monotherapy (160 mg/day). Compared with normal controls of similar age, our patients had a larger left ventricular mass and impaired left ventricular filling indices. Following sotalol, mean arterial pressure (MAP) decreased by 14%, the heart rate by 15% and left ventricular mass by 11%, while diastolic filling improved (A:E 17% and PFR 21%). Six patients had a decrease in left ventricular mass of greater than 15% (group A); other patients (group B) showed a smaller reduction. In spite of comparable changes in MAP and heart rate in groups A and B, the patients in group A showed a smaller degree of improvement in the A:E ratio. It is concluded that sotalol can induce regression of left ventricular hypertrophy and improve left ventricular filling in hypertensive patients, and it seems that improvement in diastolic filling is related to a reduction in afterload rather than to a decrease in left ventricular mass.