Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996).
OBJECTIVE
To provide an update on the ability of different antihypertensive drugs to reduce left ventricular hypertrophy in essential hypertension.


METHODS
Relevant medical databases including MEDLINE, BIOSIS PREVIEWS, EMBASE, and SCISEARCH as well as review articles to December 1996.


METHODS
Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design.


METHODS
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.


RESULTS
Fifty studies published till the end of December 1996 were identified. They comprised a total of 1715 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: 9.0-14.5%), 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.
Schmieder
R E
RE
Department of Medicine IV, University of Erlangen-Nürnberg, Nürnberg, Germany.
Schlaich
M P
MP
Klingbeil
A U
AU
Martus
P
P
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016208:Databases, Factual; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics