Effects of dual blockade of Renin-Angiotensin system on concentric left ventricular hypertrophy in essential hypertension: a randomized, controlled pilot study

Autor: Andrea Maria Maresca, Achille Venco, Anna Maria Grandi, Chiara Marchesi, Emanuela Laurita, E. Nicolini, Monica Gianni, Francesco Solbiati, Luigina Guasti
Rok vydání: 2008
Předmět:
Male
Angiotensin receptor
Tetrazoles
BLOOD-PRESSURE
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Pilot Projects
ANTIHYPERTENSIVE TREATMENT
Essential hypertension
Left ventricular hypertrophy
Renin-Angiotensin System
Ramipril
CONVERTING ENZYME-INHIBITION
biology
Drug Synergism
Middle Aged
DIASTOLIC HEART-FAILURE
CONVERTING ENZYME-INHIBITION
DIASTOLIC HEART-FAILURE
CENTRAL AORTIC PRESSURE
RECEPTOR BLOCKER
ANTIHYPERTENSIVE TREATMENT
COMBINATION THERAPY
BLOOD-PRESSURE
II GENERATION
ACE-INHIBITOR
MASS
Treatment Outcome
Hypertension
Cardiology
Drug Therapy
Combination
Female
Hypertrophy
Left Ventricular
medicine.drug
Adult
medicine.medical_specialty
CENTRAL AORTIC PRESSURE
Concentric hypertrophy
MASS
II GENERATION
ACE-INHIBITOR
Internal medicine
Internal Medicine
medicine
Humans
cardiovascular diseases
Systole
RECEPTOR BLOCKER
business.industry
Biphenyl Compounds
Angiotensin-converting enzyme
medicine.disease
COMBINATION THERAPY
Candesartan
biology.protein
Benzimidazoles
business
Angiotensin II Type 1 Receptor Blockers
Zdroj: American journal of hypertension. 21(2)
ISSN: 0895-7061
Popis: BACKGROUND: The renin-angiotensin system (RAS) plays a major role in promoting left ventricular (LV) remodeling in essential hypertension. We designed a controlled, randomized pilot study aimed to test the hypothesis that the dual RAS blockade with angiotensin-converting enzyme (ACE) inhibitor (ACEi) + angiotensin II receptor blocker (ARB) can be more effective in decreasing LV hypertrophy and improving diastolic function than a largely employed association such as ACEi + calcium-antagonist (Ca-A). METHODS: Twenty-four never-treated hypertensive patients with LV concentric hypertrophy were randomized to ramipril + candesartan or ramipril + lercanidipine. Before and after the 6-month treatment they underwent a 24-h blood pressure (BP) monitoring and echocardiographic examination. RESULTS: At baseline, age, body mass index (BMI), 24-h BP, and LV morpho-functional parameters were similar between the two groups. The 6-month treatment induced in both groups a significant decrease of 24-h BP, septal and posterior wall thickness, and LV mass index (LVMi) (ACEi + ARB 155 +/- 19 to 122 +/- 17 g/m(2), P < 0.0001; ACEi + Ca-A 146 +/- 18 to 127 +/- 20 g/m(2), P < 0.0001). Systolic function remained unchanged; LV diastolic parameters increased significantly in both groups. The extent of 24-h BP decrease was similar between the two groups (-13.3/16.3% vs. -12.3/15.8%, P = 0.63/P = 0.71), whereas the decrease of LV mass (-22% vs. -12.8%, P < 0.005) and the improvement of diastolic function were greater in ACEi + ARB group. CONCLUSIONS: In comparison with ACEi + Ca-A, ACEi + ARB treatment showed a greater antiremodeling effect, that can be reasonably ascribed to a BP-independent effect of the dual RAS blockade.
Databáze: OpenAIRE
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