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Effect of amlodipine on left ventricular mass in the Amlodipine Cardiovascular Community Trial
R A Kloner1, J R Sowers, G F DiBona
1Heart Institute of the Hospital of the Good Samaritan, Los Angeles, California 90017, USA.
Insights
Amlodipine besylate effectively reduced left ventricular hypertrophy (LVH) in hypertensive patients. This calcium channel blocker significantly lowered blood pressure and showed promise in managing LVH, particularly in Black patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension is a significant risk factor for left ventricular hypertrophy (LVH).
- Left ventricular hypertrophy (LVH) is associated with increased cardiovascular risk.
- Amlodipine is a calcium channel blocker used for hypertension treatment.
Purpose of the Study:
- To evaluate the effect of amlodipine besylate on the regression of left ventricular hypertrophy (LVH) in patients with mild to moderate hypertension.
- To assess changes in left ventricular mass and blood pressure in response to amlodipine therapy.
Main Methods:
- A subset of patients from the Amlodipine Cardiovascular Community Trial (ACCT) with baseline LVH underwent echocardiography.
- Echocardiograms were repeated after 18 weeks and in some cases at 42 weeks of amlodipine therapy (5-10 mg/day).
- Blood pressure measurements (SBP and DBP) were recorded at baseline and during therapy.
Main Results:
- 37% of hypertensive patients screened had LVH at baseline.
- Black patients exhibited a higher incidence of LVH (64%) compared to white patients (34%).
- Amlodipine therapy significantly reduced SBP and DBP from 163/102 mm Hg to 139/86 mm Hg at week 18 (p < 0.0001).
Conclusions:
- Amlodipine besylate therapy led to significant reductions in blood pressure in hypertensive patients.
- The study suggests amlodipine may contribute to the regression of left ventricular hypertrophy (LVH).
- Further research is warranted to confirm amlodipine's role in LVH regression and its differential effects across racial groups.
Abstract:
As part of the Amlodipine Cardiovascular Community Trial (ACCT), which was a large multicenter study designed to assess the effects of the calcium channel blocker amlodipine besylate (Norvasc) as monotherapy for treatment of mild to moderate hypertension, we sought to determine the effects of amlodipine on regression of left ventricular (LV) hypertrophy (LVH). The study began with a 2-week placebo run-in period (baseline), before which antihypertensive drugs had been discontinued. Amlodipine was then administered at 5-10 mg/day during a 4-week titration/efficacy period. Patients achieving a goal diastolic blood pressure (DBP) of < or = 90 mm Hg or a decrease in DBP of > or = 10 mm Hg entered a 12-week maintenance phase and had the option to continue long-term therapy thereafter. Echocardiograms were obtained in a subset of patients at the end of the baseline period. In patients with LVH at baseline, echocardiograms were repeated at the end of 16 weeks of therapy (week 18), and at 42 weeks in patients continuing long-term therapy. Thirty-seven percent of 124 hypertensive patients screened for LVH at baseline had LVH detected on echocardiograms. Blacks had a higher incidence of LVH (64%) as compared with whites (34%, p < 0.05). Patients with LVH were more likely to have a higher baseline systolic BP (SBP) and DBP. Their sitting SBP and DBP decreased significantly from a mean of 163/102 mm Hg at baseline to 139/86 mm Hg with amlodipine therapy at week 18 (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)