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Beta-blockers vs. angiotensin-converting enzyme inhibitors in hypertension: effects on left ventricular hypertrophy
P Gosse1, R Roudaut, G Herrero
1Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Régional de Bordeaux, Pessac, France.
Insights
Beta-blockers and ACE inhibitors effectively lower blood pressure and reduce left ventricular mass in hypertensive patients. This study found both bisoprolol and enalapril equally effective in reducing blood pressure and left ventricular mass index.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension is a significant risk factor for cardiovascular disease.
- Left ventricular hypertrophy (LVH) is a common adaptation to hypertension.
- Beta-blockers and ACE inhibitors are known to cause LVH regression, but direct comparisons are limited.
Purpose of the Study:
- To compare the efficacy of bisoprolol (a beta-blocker) and enalapril (an ACE inhibitor) in reducing blood pressure and left ventricular mass index in hypertensive patients.
- To assess the impact of these drugs on left ventricular filling dynamics.
Main Methods:
- A randomized study involving 56 hypertensive patients.
- Patients were randomized to receive either bisoprolol or enalapril once daily.
- Assessments included office and 24-h ambulatory blood pressure monitoring, M-mode echocardiography for left ventricular mass index and fractional shortening, and Doppler evaluation of left ventricular filling at baseline and after 6 months.
Main Results:
- Both bisoprolol and enalapril significantly reduced office and 24-h blood pressure.
- Both drugs significantly reduced left ventricular mass index (11% with bisoprolol, 7% with enalapril).
- Fractional shortening remained unchanged; early to late diastolic left ventricular flow ratio increased with bisoprolol, primarily due to heart rate reduction.
Conclusions:
- Bisoprolol and enalapril demonstrate similar efficacy in lowering blood pressure and reducing left ventricular mass index in hypertensive patients.
- No correlation was found between blood pressure reduction and left ventricular mass index reduction.
- Both drug classes are effective in managing hypertensive cardiac remodeling.
Abstract:
Both beta-blockers and angiotensin-converting enzyme (ACE) inhibitors have been shown to cause left ventricular hypertrophy regression in hypertensive patients. So far, no study allowed a true comparison of these drugs in this regard. Therefore, 56 hypertensive patients (38 newly recognized and 18 without any antihypertensive drugs for more than 2 months, mean of 9.5+/-14 months) were randomized to enalapril (En, n = 30) or a beta-blocker, bisoprolol (Bi, n = 26), once daily and underwent before and after 2 and 6 months on treatment (a) office and 24-h ambulatory monitoring of BP, (b) M-mode echo assessment of left ventricular mass (LVM) index and fractional shortening (FS), and (c) Doppler evaluation of left ventricular filling. All recordings were read blindly by two observers. The intraobserver coefficient of variation of LVM was 9%. After 6 months, office BP (146+/-18/90+/-10 vs. 170+/-14/104+/-8 mm Hg) and 24-h BP(120+/-17/77+/-9 vs. 138+/-15/90+/-9 mm Hg) were similarly reduced with both drugs. The LVM index was significantly reduced (p < 0.001) (Bi, 11%; En, 7%) and FS was unchanged. The early to late diastolic left ventricular flow ratio (E/A) was increased with bisoprolol (1.06+/-0.29 vs. 0.85+/-0.17, p < 0.0001) but not with enalapril (0.95+/-0.24 vs. 0.88+/-0.34), but this was mainly due to heart rate reduction with bisoprolol. We found no correlation between the reductions in 24-h BP and in LVM index. Bisoprolol and enalapril were similarly effective in lowering blood pressure (BP) in the office and during 24-h monitoring and in reducing the left ventricular mass index in hypertensive patients.