Effects of Dual Blockade of Renin–Angiotensin System on Concentric Left Ventricular Hypertrophy in Essential Hypertension: a Randomized, Controlled Pilot Study

• Published in: American journal of hypertension Vol. 21; no. 2; pp. 231 - 237
• Main Authors: Grandi, Anna M., Solbiati, Francesco, Laurita, Emanuela, Maresca, Andrea M., Nicolini, Eleonora, Marchesi, Chiara, Gianni, Monica, Guasti, Luigina, Venco, Achille
• Format: Journal Article
• Language: English
• Published: New York, NY Oxford University Press 01.02.2008; Elsevier Science
• Subjects: Adult; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Arterial hypertension. Arterial hypotension; Benzimidazoles - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Drug Synergism; Drug Therapy, Combination; Female; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertrophy, Left Ventricular - drug therapy; Hypertrophy, Left Ventricular - etiology; Male; Medical sciences; Middle Aged; Pilot Projects; Ramipril - therapeutic use; Renin-Angiotensin System - drug effects; Tetrazoles - therapeutic use; Treatment Outcome; Hypertension; Cardiovascular disease; Renin angiotensin system; Left ventricle
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1038/ajh.2007.47

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/m2, P < 0.0001; ACEi + Ca-A 146 ± 18 to 127 ± 20 g/m2, 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.