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Greater regression of electrocardiographic left ventricular hypertrophy during hydrochlorothiazide therapy in

Peter M Okin1, Darcy A Hille, Sverre E Kjeldsen

  • 1Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York, USA. pokin@med.cornell.edu

American Journal of Hypertension
|April 17, 2010
PubMed

Insights

Hydrochlorothiazide (HCTZ) use significantly improved electrocardiographic left ventricular hypertrophy (LVH) regression. This effect was more pronounced in patients receiving losartan compared to atenolol, independent of blood pressure changes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Hypertension Research

Background:

  • Losartan-based regimens showed greater regression of electrocardiographic (ECG) left ventricular hypertrophy (LVH) than atenolol in the LIFE study, irrespective of blood pressure (BP) changes.
  • The independent effect of concomitant hydrochlorothiazide (HCTZ) therapy on LVH regression and its interaction with treatment arms was not previously examined.

Purpose of the Study:

  • To investigate whether hydrochlorothiazide (HCTZ) therapy enhances left ventricular hypertrophy (LVH) regression independently of blood pressure (BP) changes.
  • To determine if the effect of HCTZ on LVH regression differs between losartan- and atenolol-based treatment regimens.

Main Methods:

  • Assessed changes in Cornell product and Sokolow-Lyon voltage LVH in 9,193 hypertensive patients randomized to losartan or atenolol.
  • Hydrochlorothiazide (HCTZ) was added as needed to achieve target blood pressure (BP) goals per protocol.

Main Results:

  • Hydrochlorothiazide (HCTZ) therapy was associated with greater regression of both Cornell product and Sokolow-Lyon voltage LVH at year-4 follow-up, after adjusting for multiple clinical factors.
  • This LVH regression effect of HCTZ was significantly more pronounced in patients treated with losartan compared to those on atenolol (P < 0.001 for interaction).

Conclusions:

  • Hydrochlorothiazide (HCTZ) use promotes greater regression of ECG-defined LVH.
  • The beneficial effect of HCTZ on LVH regression is significantly enhanced when combined with losartan-based therapy versus atenolol-based therapy, independent of BP control and baseline LVH severity.
Abstract

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