Nephrology Dialysis Transplantation, Vol 13, Issue 3 564-569, Copyright © 1998 by Oxford University Press
R Schmieder, M Schlaich, A Klingbeil and P Martus
Objective: To provide an update on the ability of
different antihypertensive drugs to reduce left ventricular hypertrophy in
essential hypertension. Data sources. Relevant medical
databases including MEDLINE, BIOSIS PREVIEWS, EMBASE, and SCISEARCH as well
as review articles to December 1996. Study selection:
Meta-analysis of all published articles including only double-blind,
randomized, controlled clinical studies with parallel-group design.
Data extraction: Literature search and data extraction
according to a prefixed scheme performed independently by two
investigators. The primary parameter was reduction of left ventricular mass
by antihypertensive therapy with placebo, diuretics, {beta}-blockers,
calcium channel blockers, or ACE-inhibitors. Data
synthesis: Fifty studies published till the end of December 1996
were identified. They comprised a total of 1615 patients in 13 placebo
(n=165, age; 50±3 years) and 89 active treatment arms (n=1550,
age: 56±10 years) respectively. Overall, for active treatment
left ventricular mass index was the more reduced the greater the decrease
in systolic blood pressure, (r=0.27; P<0.05), the longer the
duration of therapy (r=0.36; P<0.001), and the higher the
pretreatment value of left ventricular mass index (r=0.53; P<0.001).
Left ventricular mass index was decreased by 12% with ACE-inhibitors (95%
CI: 9.0-15.5%), by 11% with calcium channel blockers (95% CI: 7.8-13.7%),
by 5% with {beta}-blockers (95% CI: 1.2-7.3%) and by 8% with diuretics
(95% CI: 3.9-11.1%) overall P<0.01). Subsequent tests revealed that
ACE-inhibitors and calcium channel blockers were more effective than
{beta}-blockers in reducing left ventricular mass index (P<0.05).
Similar differences between drug classes were found with regard to effect
on left ventricular wall thickness (P<0.05).
Conclusions: Decrease in systolic blood pressure,
duration of antihypertensive therapy, degree of pretreatment left
ventricular hypertrophy and antihypertensive drug class determined the
reduction of left ventricular hypertrophy. ACE-inhibitors and calcium
channel blockers were more potent in reducing left ventricular mass than
{beta}-blockers, with diuretics in the intermediate range.
ORIGINAL ARTICLES
Meta-analysis. Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996)
Department of Medicine IV, Universitat Erlangen-Nurnberg, Breslauer Strasse 201, D-90471 Nurnberg, Germany; Corresponding author
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