Reversal of left ventricular hypertrophy in essential hypertension

Antihypertensive treatment reduces left ventricular mass. ACE inhibitors may be more effective than beta-blockers or diuretics.

A systematic review including 39 studies with a total of 1,394 subjects was abstracted in DARE. Left ventricular mass index was reduced significantly in the antihypertensive treatment arms compared with placebo (p<0.04). The greater the pre-treatment left ventricular mass index the more marked was the decline in the index associated with antihypertensive drug therapy (p<0.001). Left ventricular mass decreased 13% (95% CI 9.9% to 16.8%) with ACE inhibitors, 9% (95% CI 5.5% to 13.1%) with calcium channel blockers, 6% (95% CI 2.3% to 8.6%) with beta-blockers, and by 7% (95% CI 3.0% to 10.7%) with diuretics. ACE inhibitors tended to reduce left ventricular mass more than beta-blockers and diuretics.

Another systematic review abstracted in DAREincluded 50 RCTs with a total of 1715 patients. According to the review, decrease in systolic blood pressure, duration of antihypertensive therapy and antihypertensive drug class determined the reduction of lef ventricular hypertrophy. ACE inhibitors and calcium channel blockers were more potent in reducing left ventricular mass than beta-blockers, with diuretics in the intermediate range.

A meta-analysis included 78 studies (84 randomized pairwise comparisons) with a total of 6001 subjects. The effects of diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers on left ventricular mass (LVM) regression were compared in patients with hypertension. Overall, LVM was reduced by 10.3±0.88% (P<0.001) from a baseline value of 248±4.4 g and LVM index by 11.0±0.60% (P<0.001) from a baseline value of 132±1.6 g/m². Regression of LVM was significantly less with beta-blockers than with angiotensin receptor blockers (9.8% vs. 12.5%; P=0.01), but none of the other analyzable pairwise comparisons between drug classes revealed significant differences. Beta-blockers showed less regression than the other 4 classes combined (P<0.01), and regression was more pronounced with angiotensin receptor blockers versus the others (P<0.01).

Comment: The relationship of left ventricula mass reduction by drug therapy and patient-important outcomes is unclear.

Ədəbiyyat

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