Impact of amlodipine or ramipril treatment on left ventricular mass and carotid intima-media thickness in nondiabetic hemodialysis patients.
OBJECTIVE
Left ventricular hypertrophy (LVH) and atherosclerosis are frequently observed in uremic patients and they have appeared as an independent predictor of cardiovascular morbidity and mortality. The aim of this study was to compare the effects of ramipril and amlodipine on left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) in nondiabetic hypertensive hemodialysis patients.


METHODS
A total of 112 hemodialysis (HD) patients were included in this study. Patients were randomly allocated to receive ramipril or amlodipine for 1 year. Blood pressure (BP) measurements, LVMI, and CIMT were assessed at baseline and 6-month intervals. Biochemical parameters and inflammatory markers were also determined at the initiation and during the study period.


RESULTS
Similar BP decrease was observed in treatment groups. During follow-up, LVMI and CIMT progressed likewise in both treatment groups despite BP control. However, subgrouping analyses due to the pattern of left ventricular geometry showed that LVMI in patients with eccentric LVH increased, whereas LVMI decreased in subjects with concentric LVH under antihypertensive treatment.


CONCLUSIONS
BP control with ramipril or amlodipine could not provide adequate protection for development or progression of atherosclerosis and eccentric type of LVH in nondiabetic HD patients.
Yilmaz
Rahmi
R
Department of Nephrology, Medical Faculty of Hacettepe University, Ankara, Turkey. drrahmiy@hotmail.com
Altun
Bulent
B
Kahraman
Serkan
S
Ozer
Necla
N
Akinci
Devrim
D
Turgan
Cetin
C
D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000187:drug effects; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use*; D006435:Renal Dialysis; D013318:Stroke Volume; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000187:drug effects; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000187:drug effects; D014463:Ultrasonography
D000959:Antihypertensive Agents; D017311:Amlodipine; D017257:Ramipril