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Regression of left ventricular mass in hypertensive patients treated with perindopril/indapamide as a first-line
Nicola de Luca1, Jean-Michel Mallion, Michael F O'Rourke
1Clinica Medica, Napoli, Italy. nideluca@unina.it
Insights
The perindopril/indapamide combination significantly reduced left ventricular mass (LVM) and LV hypertrophy in hypertensive patients more effectively than atenolol. This finding highlights a superior treatment option for managing cardiac remodeling in hypertension.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Elevated left ventricular mass (LVM) is linked to poor outcomes in hypertensive individuals.
- Arterial stiffness, systolic blood pressure (BP), and pulse pressure (PP) are key determinants of LVM.
- The perindopril/indapamide combination shows greater efficacy than atenolol in normalizing BP and arterial function.
Purpose of the Study:
- To compare the effectiveness of a first-line perindopril/indapamide combination versus atenolol in reducing LVM in hypertensive patients.
- To assess the impact of these treatments on echocardiographic indices of left ventricular hypertrophy.
Main Methods:
- A randomized, double-blind, parallel-group study (REASON) involving 214 patients with essential hypertension.
- M-mode two-dimensional-guided echocardiography was used to measure LVM and related indices.
- Patients were treated for 12 months with either perindopril (2 mg)/indapamide (0.625 mg) or atenolol (50 mg).
Main Results:
- Both treatments effectively reduced brachial BP over 12 months.
- Perindopril/indapamide achieved a significantly greater reduction in systolic BP compared to atenolol.
- The perindopril/indapamide group showed significantly greater regression of LVM, LVMI1, and LVMI2 compared to the atenolol group, particularly in patients with baseline LV hypertrophy.
Conclusions:
- First-line treatment with perindopril/indapamide is more effective than atenolol for reducing echocardiographic indices of LVM and LV hypertrophy in hypertensive patients.
- This combination therapy offers a superior approach to managing cardiac remodeling associated with hypertension.
Background:
Increase in left ventricular mass (LVM) may be linked to morbidity and mortality in hypertensive patients. Arterial stiffness, systolic blood pressure (BP), and pulse pressure (PP) seem to be the main determinants of LVM. The perindopril/indapamide combination normalizes systolic BP, PP, and arterial function to a greater extent than atenolol. The aim of this study was to compare the effects of perindopril (2 mg)/indapamide (0.625 mg) first-line combination with atenolol (50 mg) on LVM reduction in hypertensive patients.
Methods:
Two hundred fourteen patients with essential hypertension participating in the PREterax in Regression of Arterial Stiffness in a ContrOlled Double-BliNd (REASON), randomized, double-blind, parallel-group study, underwent M-mode two-dimensional-guided echocardiography.
Results:
Perindopril/indapamide and atenolol were both effective at brachial BP reduction during the 12-month period. The systolic BP reduction was significantly greater with perindopril/indapamide than with atenolol (-21.2 v -15.3 mm Hg), whereas the reduction in diastolic BP was similar between treatment groups (-12.1 v -11.3 mm Hg). Reduction in LVM was higher with perindopril/indapamide than with atenolol. The between-group difference was significant for LVM (-13.6 v -4.3 g, P = .027), LVM/body surface area (LVMI1, P = .032), and LVM/body height2.7 (LVMI2, P = .013). The 124 patients with LV hypertrophy at baseline showed greatest LVM regression (LVM: -22.5 v -8.9 g, P = .009; LVMI1, P = .031; LVMI2, P = .028). The reduction in LVM adjusted for brachial systolic BP and heart rate was still significantly greater with perindopril/indapamide than with atenolol.
Conclusions:
Treatment, based on a first-line perindopril/indapamide combination in hypertensive patients, was more effective than atenolol on regression of echocardiographic indices of LVM and LV hypertrophy.
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