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Ramipril-induced regression of left ventricular hypertrophy in treated hypertensive individuals. HYCAR Study Group
Insights
Ramipril significantly reduced left ventricular mass in hypertensive patients with left ventricular hypertrophy. The regular dose (5 mg) showed a greater effect than the low dose (1.25 mg) compared to placebo.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- LVH is associated with increased cardiovascular risk.
- Effective antihypertensive therapies are needed to regress LVH.
Purpose of the Study:
- To evaluate the effect of two doses of ramipril on left ventricular mass in hypertensive patients with LVH.
- To determine if blood pressure changes mediate the effect of ramipril on LVH.
Main Methods:
- A 6-month, double-blind, randomized trial involving 115 hypertensive patients with LVH.
- Patients received placebo, low-dose (1.25 mg) ramipril, or regular-dose (5 mg) ramipril daily, with continued furosemide therapy.
- Left ventricular mass was assessed using echocardiography before and after treatment.
Main Results:
- No significant differences in blood pressure changes were observed between groups.
- The 5 mg ramipril group showed a significant reduction in left ventricular mass index compared to placebo (P = .008).
- The 1.25 mg ramipril group showed a borderline significant reduction in LV mass index (P = .06).
Conclusions:
- Ramipril effectively reduces left ventricular mass in hypertensive patients with LVH, independent of significant blood pressure changes.
- Higher doses of ramipril may offer greater regression of left ventricular mass.
Abstract:
The objective of this trial was to assess the effects of 6-month daily treatment with two doses of ramipril on left ventricular mass and the dependence of this on blood pressure changes in hypertensive patients with left ventricular hypertrophy. After a selection phase of 4 to 6 weeks with patients under antihypertensive therapy with 20 mg furosemide daily, 115 patients with either controlled or uncontrolled hypertension and left ventricular hypertrophy were randomized in a double-blind manner to receive either placebo (n = 40), 1.25 mg (low dose, n = 38), or 5 mg (regular dose, n = 37) ramipril daily for 6 months. Treatment with furosemide was continued unchanged during this phase. The main outcome measured was left ventricular hypertrophy regression as assessed from central blind reading of echocardiograms recorded at randomization and after 6 months. No significant differences were observed for changes in casual or ambulatory blood pressure between the three groups. Left ventricular mass index was found to be significantly reduced in patients receiving 5 mg ramipril compared with those receiving placebo (-10.8 +/- 3.7 versus +4.1 +/- 4.0 g/m2, P = .008); in patients receiving 1.25 mg ramipril, the difference was close to borderline significance compared with placebo (-7.0 +/- 4.3 g/m2, P = .06). Similar results were observed for changes in left ventricular mass (-20.3 +/- 6.6 and -13.0 +/- 7.8 g in the 5- and 1.25-mg ramipril groups, respectively, versus +9.1 +/- 7.2 g in the placebo group; P = .004 and .04, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)