Effect of ramipril on left ventricular mass in normotensive hemodialysis patients.
BACKGROUND
Normotensive hemodialysis patients may still have left ventricular hypertrophy in the absence of significant pressure or volume overload. We examined the hypothesis that treatment with an angiotensin-converting enzyme inhibitor could be beneficial in the reversal of left ventricular hypertrophy in these patients.


METHODS
Forty-six normotensive patients with end-stage renal disease on regular hemodialysis therapy were randomly assigned to administration of ramipril, 2.5 mg 3 times/wk, or placebo for 1 year. Left ventricular mass index and parameters of cardiovascular structure and function were evaluated noninvasively by means of echocardiography and arterial tonometry at baseline, 6 and 12 months after treatment, and 1 month after washout.


RESULTS
In the ramipril group, blood pressure decreased significantly at 6 and 12 months after treatment. There were no significant within-group or between-group differences in left ventricular mass index at entry, 6 and 12 months after treatment, and 1 month after washout. There were no significant differences in left atrial dimension, left ventricular size and wall thickness, left ventricular ejection fraction, aortic dimension, intima-media thickness, elastic modulus and augmentation index of the common carotid artery, and aortic pulse wave velocity between the ramipril and placebo groups at entry, 6 and 12 months after treatment, and 1 month after washout.


CONCLUSIONS
A 12-month treatment with ramipril did not cause significant regression of left ventricular hypertrophy in normotensive hemodialysis patients. Results may suggest that the renin-angiotensin system has little role in the pathogenesis of mild left ventricular hypertrophy in these patients.
Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Wen-Chung
WC
Yu
Yao-Ping
YP
Lin
I-Feng
IF
Lin
Shao-Yuan
SY
Chuang
Chen-Huan
CH
Chen
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril