title: Suppression of aldosterone mediates regression of left ventricular hypertrophy in patients with hypertension.
abstract: BACKGROUND
  High circulating aldosterone levels stimulate myocardial fibrosis and left ventricular hypertrophy (LVH). However, it is not clear whether suppression of aldosterone directly contributes to LVH regression in hypertensive patients.
  
  
  METHODS
  The Aliskiren in Left Ventricular Hypertrophy (ALLAY) trial randomised 465 hypertensive overweight subjects with LVH to the direct renin inhibitor aliskiren 300 mg, losartan 100 mg or the combination and followed patients for 9 months. All patients were treated to standard blood pressure targets. Left ventricular (LV) mass index (LVMI) and LV wall thickness (LVWT) were assessed by cardiac magnetic resonance. A subset of 136 patients who had plasma aldosterone concentration (ALDO) measured at baseline and study end was analysed.
  
  
  RESULTS
  At baseline, plasma ALDO was modestly related to systolic blood pressure, LVMI, and wall thickness (all, p < 0.05). Aliskiren, either alone or in combination, was associated with a significantly greater reduction from baseline to 9 months in plasma aldosterone than losartan alone (p < 0.02). Reduction in ALDO was related to reduction in LVMI even after adjustment for baseline ALDO, BP reduction and treatment group (p for trend = 0.042).
  
  
  CONCLUSIONS
  In hypertensive patients with increased LVWT, aliskiren alone or in combination with the angiotensin receptor blocker losartan provides greater reduction in aldosterone compared to losartan alone. Moreover, suppression of aldosterone was associated with reduction of LVH, independently of the change in SBP, suggesting that suppression of aldosterone, a known mediator of LVH, may be particularly important for LVH regression and as a target for therapy.
authors: Brigham and Women's Hospital, Boston, MA 02115 , USA.
authors: Anne-Catherine
authors: AC
authors: Pouleur
authors: Hajime
authors: H
authors: Uno
authors: Margaret F
authors: MF
authors: Prescott
authors: Akshay
authors: A
authors: Desai
authors: Evan
authors: E
authors: Appelbaum
authors: Valentina
authors: V
authors: Lukashevich
authors: Beverly A
authors: BA
authors: Smith
authors: Björn
authors: B
authors: Dahlöf
authors: Scott D
authors: SD
authors: Solomon
mesh_terms: D000450:Aldosterone / Q000097:blood*; D000577:Amides / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003710:Demography; D005260:Female; D005650:Fumarates / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D019808:Losartan / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000187:drug effects; D013599:Systole / Q000187:drug effects
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D000450:Aldosterone; C446481:aliskiren; D019808:Losartan