MORE--MOexipril and REgression of left ventricle hypertrophy in combination therapy A multicentric open label clinical trial.
OBJECTIVE
To evaluate the effect of ACE inhibitor moexipril if added to combination therapy in patient with poorly controlled hypertension.


METHODS
Four hundred twenty patients with hypertension treated with monotherapy or two dug combination without an ACE inhibitor or AII antagonist and with blood pressure >/=140/90 mm Hg.


METHODS
Single-blind, multicenter, open, with a double-blind echocardiographic examination.


METHODS
Basic cardiological examination including echocardiography was performed before including into the study. If the patient fulfilled inclusion criteria, ACE inhibitor moexipril was added to the therapy and uptitrated according to BP values. BP measuring, clinical examination, and basic laboratory were performed every month, echocardiography was repeated after 6 months.


RESULTS
Sitting BP decreased from 161.43+/-12.84/96.72+/-7.74 mm Hg to 135.87+/-9.98/82.36+/-5.83 mm Hg (p<0.0001), heart rate from 73.08+/-9.87 to 69.80+/-7.91 (p<0.0001). Three hundred forty patients (81%) had BPd <90 mm Hg after 6 months. Left ventricle mass decreased from 263.24+/-94.69 to 246.71+/-89.08 g (p<0.0001), left atrium decreased from 39.78+/-5.40 to 38.89+/-4.98 mm (p<0.0001), and E/A ratio increased from 0.91+/-0.28 to 0.94+/-0.27 (p<0.0005). Plasma cholesterol level decreased from 5.67+/-0.87 to 5.44+/-0.68 mmol/l (p<0.0001) and plasma triglycerides decreased from 1.92+/-1.07 to 1.78+/-0.80 mmol/l (p<0.001). A greater effect on blood pressure reduction was observed in combination ACE-I+diuretics than in combination ACE-I+betablocker or ACE-I+Ca blocker (statistically borderline). A statistically greater effect on left ventricle mass was observed if moexipril was added to a diuretic than to Ca blocker (p=0.02) or betablocker (p=0.04).


CONCLUSIONS
ACE inhibitor moexipril added to combination therapy of hypertension had similar effect on blood pressure reduction and left ventricle mass as in monotherapy trials. The most effective combination is ACE ihibitor+thiazide diuretic. A very small number of adverse events was observed; cough was reported in 2.14% of patients. Decreased heart rate and improvement in lipid parameters were observed in the whole group.
Spinar
J
J
Department of Internal Medicine II, St Ann's Teaching Hospital, Brno, Czech Republic. jspinar@med.muni.cz
Vítovec
J
J
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D001581:Benzothiadiazines; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D004232:Diuretics; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016037:Single-Blind Method; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D044005:Tetrahydroisoquinolines; C058302:moexipril