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[Management of hypertensive patients with left ventricular hypertrophy]
1Service de Médecine interne, Université de Bologne, Italie.
Insights
Left ventricular hypertrophy (LVH) increases cardiovascular risk. The LIVE study found slow-release indapamide superior to enalapril in reducing LVH in hypertensive patients, with similar blood pressure control.
Area of Science:
- Cardiology
- Hypertension Management
- Diabetology
Background:
- Left ventricular hypertrophy (LVH) is a significant independent risk factor for cardiovascular disease.
- In type 2 diabetes patients, LVH is primarily linked to hypertension, arterial stiffness, and endothelial dysfunction.
- Factors like obesity and hyperinsulinism can exacerbate LVH.
Purpose of the Study:
- To compare the efficacy of slow-release indapamide versus enalapril 20 mg in reducing left ventricular mass index (LVMI) in hypertensive patients with LVH.
- To evaluate the impact of these treatments on cardiovascular risk factors.
Main Methods:
- The LIVE study was the first multicentric European trial of its kind.
- Involved randomized, centralized, and blinded reading of echocardiograms.
- Compared slow-release indapamide with enalapril 20 mg in hypertensive subjects with LVH.
Main Results:
- Indapamide SR demonstrated superiority over enalapril 20 mg in reducing LVMI.
- Both treatments showed comparable blood pressure-lowering effects.
- This highlights a potential advantage for indapamide SR in managing LVH.
Conclusions:
- Slow-release indapamide is more effective than enalapril 20 mg in reducing LVMI in hypertensive patients with LVH.
- Early screening and treatment of LVH are crucial for cardiovascular disease prevention.
- Indapamide SR offers a promising therapeutic option for this patient group.
Abstract:
CARDIOVASCULAR RISK OF LEFT VENTRICULAR HYPERTROPHY: Because of the rhythmic, mechanical and ischemic risk related to it, the left ventricular hypertrophy (LVH) is considered to be a major independent risk factor for cardiovascular disease which should be screened for and treated early. In patients with type 2 diabetes, left ventricular hypertrophy is mainly due to high blood pressure, but also to reduced elasticity of the large vessels, defective vasomotricity and dysfunction of the arterial endothelium. Obesity, elevated blood viscosity, hyperinsulinism and/or autonomous cardiac neuropathy can also have a favoring effect. THE LIVE STUDY: Is the first multicentric European study comparing the efficacy of a thiazide-like diuretic, slow-release indapamid, with a converting enzyme inhibitor, enalapril 20 mg, on the reduction of the left ventricular mass index (LVMI) in hypertensive subjects with LVH. The study involved a randomized centralized reading of the echocardiograms as well as a randomized and blinded reading at the end of the study. DEMONSTRATED SUPERIORITY OF INDAPAMID SR: The LIVE study clearly demonstrated the superiority of indapamid SR over enalapril 20 mg in reducing the LVMI in hypertensive subjects with LVH while the blood pressure lowering effect was comparable for the two treatments.