Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive...

Area of Science:

• Cardiology
• Pharmacology
• Hypertension Research

Background:

• The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) investigated left ventricular (LV) mass reduction.
• The study aimed to compare enalapril with nifedipine for LV mass reduction in hypertensive patients.

Purpose of the Study:

• To determine if enalapril achieves a prognostically significant greater reduction in left ventricular (LV) mass compared to nifedipine.
• To assess the comparative efficacy of enalapril and nifedipine in regressing LV hypertrophy.

Main Methods:

• A randomized, double-blind study involving 303 men and women with essential hypertension and increased LV mass.
• Echocardiography was used to measure LV mass at baseline and after 48 weeks of treatment with enalapril or nifedipine.
• Intention-to-treat analysis was performed on 113 enalapril-treated and 122 nifedipine-treated patients.

Main Results:

• Both enalapril and nifedipine demonstrated similar reductions in systolic/diastolic pressure (-22/12 vs -21/13 mm Hg) and LV mass index (-15 vs -17 g/m(2)).
• No significant differences in LV mass reduction were found across various patient subsets (monotherapy, sex, age, race, hypertrophy severity).
• Enalapril required more adjunctive hydrochlorothiazide (59% vs 34%) but similar atenolol (27% vs 22%) compared to nifedipine.

Conclusions:

• Once-daily enalapril and long-acting nifedipine, with necessary adjunctive therapy, yielded comparable and statistically indistinguishable effects on left ventricular hypertrophy regression.
• Both antihypertensive treatments provided moderately beneficial and similar outcomes in reducing LV hypertrophy.