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Angiotensin II antagonism and the heart: valsartan in left ventricular hypertrophy
1Institute of Clinical Pharmacology, University Witten/Herdecke, Wuppertal, Germany. thuermann@klinikum-wuppertal.de
Insights
Valsartan effectively reduced left ventricular mass in patients with essential hypertension and left ventricular hypertrophy (LVH). This angiotensin II receptor antagonist offers a significant therapeutic option for managing LVH and improving cardiovascular outcomes.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular disease.
- Normalizing left ventricular mass is a key objective in antihypertensive therapy.
Purpose of the Study:
- To compare the efficacy of valsartan (an angiotensin II receptor antagonist) with atenolol (a beta-blocker) in reducing left ventricular mass in patients with essential hypertension and LVH.
Main Methods:
- A randomized, double-blind study involving 69 patients with essential hypertension and LVH.
- Patients received either valsartan (80 mg/160 mg daily) or atenolol (50 mg/100 mg daily) for 8 months.
- Echocardiography was used to assess left ventricular mass index (LVMI).
Main Results:
- Both valsartan and atenolol significantly reduced blood pressure.
- Valsartan treatment led to a greater reduction in LVMI (from 127 to 106 g/m²) compared to atenolol (from 127 to 117 g/m²).
- Long-term valsartan treatment significantly reduced LVH in patients with essential hypertension.
Conclusions:
- Valsartan is effective in reducing left ventricular hypertrophy in patients with essential hypertension.
- Valsartan demonstrates a superior effect on LVH reduction compared to atenolol in this patient population.
Abstract:
Left ventricular hypertrophy (LVH) represents an independent risk factor for cardiovascular morbidity and mortality, and normalization of left ventricular mass has become a desirable goal of antihypertensive treatment. In a randomized, double-blind study the angiotensin II (AT(1) receptor) antagonist valsartan (Diovan((R)); 80 mg/160 mg q.d.) was compared with the beta-blocker atenolol (50 mg/100 mg q.d.) over 8 months in predominantly previously untreated patients with essential hypertension and LVH. Sixty-nine patients were randomized, of whom 58 were evaluated with echocardiographic data. After 8 months of treatment in the atenolol group [n = 8 with additional hydrochlorothiazide (HCTZ)], initial blood pressure was reduced from 160/103 to 147/92 mm Hg (p < 0.0001), and in the valsartan group (n = 9 with additional HCTZ) blood pressure decreased from 163/101 to 146/90 mm Hg (p < 0.0001). Left ventricular mass index decreased from 127 to 117 g/m(2) in the atenolol group and from 127 to 106 g/m(2) in the valsartan group. Long-term treatment with valsartan resulted in a significant reduction of LVH in patients with essential hypertension.