Effects of the combinations of amlodipine/valsartan versus losartan/hydrochlorothiazide on left ventricular hypertrophy as determined with magnetic resonance imaging in patients with hypertension

Oliver Bruder, Christoph J Jensen, Michael Bell, Reinhard Rummel, Guenter Boehm, Sven Klebs, Christian Sieder, Jochen Senges, Oliver Bruder, Christoph J Jensen, Michael Bell, Reinhard Rummel, Guenter Boehm, Sven Klebs, Christian Sieder, Jochen Senges

Abstract

Background: Left ventricular hypertrophy (LVH), a marker of cardiac end-organ damage, is frequently found in patients with arterial hypertension and is associated with cardiovascular and cerebrovascular morbidity and mortality. Therefore, LVH regression is an important treatment goal. For amlodipine plus valsartan (A/V) no specific study on LVH has been reported to date.

Methods: Prospective, open-label, randomized parallel-group study. Patients with essential hypertension and LVH were randomized to 52-week treatment with A/V 10/160 mg (n = 43) or the active comparator losartan/HCT 100/25 mg (L/H, n = 47). Add-on medication was allowed in case of inadequate blood pressure control. LV parameters were measured by cardiovascular magnetic resonance imaging (MRI), and adjudicated in a blinded manner. Study identifiers were NCT00446563 and EudraCT 2006-001977-17.

Results: In addition to the study treatment, 35% of patients in the A/V group and 49% in the L/H group received additional antihypertensive medication. Compared to baseline, both treatments reduced measures of LVH significantly after 52 weeks (e.g. LV mass index in the A/V group from 64.7 g/m(2) by -3.5 g/m(2), in the L/H group from 69.1 g/m(2) by -4.4 g/m(2), p < 0.01 for both). LV ejection fraction and LV volumes were not significantly changed by any regimen. A/V and L/H treatments were well tolerated.

Conclusions: Both regimen were effective in reducing LV mass compared to baseline and were well tolerated.

Keywords: A/V, amlodipine plus valsartan; Arterial hypertension; Asc. aorta, ascending aorta; BP, diastolic blood pressure; CCB, calcium channel blockers; IVS, interventricular septum thickness; L/H, losartan/hydrochlorothiazide; LA, left atrium; LVEDV, left ventricular enddiastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular endsystolic volume; LVH, left ventricular hypertrophy; LVM, left ventricular mass; LVMI, left ventricular mass index; MRI, magnetic resonance imaging; RAAS; SBP, systolic blood pressure; combination therapy; end-organ damage; left ventricular hypertrophy; magnetic resonance imaging; norm BSA, adjusted for body surface area; treatment.

Figures

Figure 1.
Figure 1.
Study design.
Figure 2.
Figure 2.
Patient flow.

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