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Mitral annular calcium (MAC) is a condition that often occurs in patients with systemic hypertension. To evaluate the effectiveness of nifedipine in preventing MAC, 223 patients with systemic hypertension of recent onset and without MAC were selected and randomly enrolled in 3 groups: group 1 (76 patients) received nifedipine; group 2 (72 patients) received enalapril; and group 3 (75 patients) received atenolol. After 5 years, these treatments significantly reduced systolic (p0.001) and diastolic (p0.05) blood pressure (BP) in 3 treated groups. M-mode echocardiography revealed MAC only in 2 patients in the nifedipine group (2.6%), in 13 in the enalapril group (18%) and in 15 in the atenolol group (20%). The degree of MAC was mild (5 mm) in the 2 patients in group 1, in 5 of the 13 in group 2, and in 6 of the 15 in the group 3, whereas it was severe (5 mm) in the remaining 8 in the enalapril group and in the other 9 in the atenolol group. There was also a significant correlation in the degree of MAC, left atrial enlargement and mitral regurgitation. In addition, atrial fibrillation and atrioventricular conduction defects were associated with severe MAC. These results indicate that nifedipine is an effective drug both in the long-term management of systemic hypertension and in preventing or delaying MAC.

Objective To identify the sequence and significance of left ventricular filling abnormalities associated with progressive aging in humans. Design Cross-sectional study comparing three age groups. Setting: Department of Geriatrics at University of Naples. Participants Seventy-five healthy subjects in three age groups: 25 subjects from 25 to 45 years (Group I), 25 subjects from 46 to 65 years (Group II), and 25 subjects from 66 to 85 years (Group III). Intervention None. Main Outcome Measures All underwent pulsed-doppler echocardiography under color guide to measure the following parameters: peak velocity flow for early (E wave) and late (A wave) mitral flow; A/E wave ratio; deceleration time of mitral flow (MDt); isovolumic relaxation time (IRT); ratio of velocity time integrals of the A wave to the velocity time integrals of the entire mitral spectrum (VTIA/VTIM). Results Peak velocity of the E wave was slightly lower in Group II and III compared to Group I; in contrast, peak velocity of the A wave was greater (P < 0.005) in aged individuals. Also A/E wave ratio, MDt, and IRT were significantly greater with advancing age (P < 0.01; P < 0.05 and P < 0.001, respectively). Finally, VTIA/VTIM tended to be greater in the oldest group, but not significantly so. Conclusions Left ventricular relaxation is progressively impaired in late middle age and old age, presumably an early marker of cardiac aging. Increased left atrial pressure is compromised only in the oldest group, presumably representing a compensation for impaired left ventricular relaxation.

Age-related changes in vascular tissue were previously reported. 1,2 Moreover, mild diffuse connective tissue proliferation of the aging lung can contribute to reduced reserve of the pulmonary vascular bed. 3 These morphologic changes may induce some hemodynamic impairment of the aging pulmonary circulation. Unlike the systemic circulation, relatively little is known regarding the effects of effort on pulmonary hemodynamics in healthy, elderly subjects. Difficulties in selecting elderly subjects without pulmonary vascular, cardiac and lung disease, and the absence of an effective, noninvasive method for the measurement of pulmonary hemodynamics are the causes for this poor knowledge. 4 In the present study, we evaluated the pulmonary hemodynamics in an elderly cohort, free of cardiovascular and lung disease, at rest and during submaximal supine exercise.