Role of plasma aldosterone concentration in regression of left-ventricular mass following antihypertensive medication.
BACKGROUND
Aldosterone is known to bring about damage to various organs; however, it is unclear how important the changes in plasma aldosterone concentration (PAC) are as contributors to regression of left-ventricular (LV) mass in hypertensive patients following long-term treatment with calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs).


OBJECTIVE
To assess the importance of changes in PAC during antihypertensive treatment.


METHODS
Forty-four untreated hypertensive patients were randomly assigned to either CCB (amlodipine) group or ARB (losartan) group. In addition to PAC measurements LV geometry was echocardiographically assessed with LV mass index (LVMI) and relative wall thickness (RWT) before and 6 and 12 months after treatment.


RESULTS
Reduction of systolic blood pressure (SBP) in 12 months was greater in the CCB group than in the ARB group (-19 ± 8 vs. -11 ± 15%, P < 0.05 as percentage reduction from the values before treatment). PAC decreased in 12 months in the ARB group but not in the CCB group (-31 ± 31 vs. 17 ± 53%, P < 0.01 as percentage reduction from the values before treatment). Larger percentage drop in PAC was associated with larger percentage reduction of LVMI (r = 0.45, P < 0.01 for all). Multiple step-wise regression analysis showed that the percentage reduction of LVMI is related to the percentage changes in SBP and the percentage changes in PAC (r = 0.46, P < 0.01).


CONCLUSIONS
Regression of LV mass was the larger in patients with the greater decrease in PAC associated with antihypertensive medication regardless of CCB or ARB. Changes in PAC and SBP may be key determinants of regression of LV mass in hypertensive patients regardless of the medication selected.
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Chikako
C
Yoshida
Akiko
A
Goda
Yoshiro
Y
Naito
Ayumi
A
Nakaboh
Mika
M
Matsumoto
Misato
M
Otsuka
Mitsumasa
M
Ohyanagi
Shinichi
S
Hirotani
Masaaki
M
Lee-Kawabata
Takeshi
T
Tsujino
Tohru
T
Masuyama
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D017311:Amlodipine / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D017311:Amlodipine; D000450:Aldosterone; D019808:Losartan