Long-term effects of irbesartan on plasma aldosterone concentration and left atrial volume in hypertensive patients.
BACKGROUND
Plasma aldosterone concentration (PAC) is related to cardiac remodeling in patients with hypertension. However, we do not know the detailed relationship between changes in PAC and regression of left atrial (LA) volume following long-term treatment with angiotensin II receptor blocker (ARB) or calcium-channel blocker (CCB).


OBJECTIVE
The aim of this study was to investigate the effects of anti-hypertensive monotherapy, an ARB irbesartan or a CCB amlodipine, on PAC and LA reverse remodeling in hypertensive patients.


METHODS
A total of 48 patients with untreated hypertension were randomly assigned to irbesartan (ARB group, n=26) and amlodipine (CCB group, n=22). We examined the correlation between LA volume index (LAVI) and other echocardiographic parameters or PAC (n=40) at the baseline and after 12 months of treatment.


RESULTS
After 12 months, blood pressure (BP) decreased similarly in both groups. LAVI and PAC significantly decreased in the ARB group, but not in the CCB group (-16±8% vs. 22±9%, p<0.01, -16±9% vs. 11±9%, p<0.05). Larger %-decrease in PAC was associated with larger %-reduction of LAVI in the ARB group (r=0.54, p<0.05), but not in the CCB group.


CONCLUSIONS
While BP reduction was similar between the two groups, decrease in LA volume was larger in the ARB group than in the CCB group. Decrease in LA volume was larger in patients with a greater decrease in PAC than in those with smaller decrease in PAC. ARB may facilitate reverse remodeling of LA through decreases in PAC in hypertensive patients.
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan; Division of Clinical Laboratory Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Mitsuru
M
Masaki
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan; Osaka Clinic, Takeda Pharmaceutical Company Limited, Osaka, Japan.
Kazuo
K
Komamura
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Akiko
A
Goda
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Shinichi
S
Hirotani
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Misato
M
Otsuka
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Ayumi
A
Nakabo
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Miho
M
Fukui
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Shohei
S
Fujiwara
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Masataka
M
Sugahara
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Masaaki
M
Lee-Kawabata
Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan.
Takeshi
T
Tsujino
Division of Clinical Laboratory Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Masahiro
M
Koshiba
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan. Electronic address: masuyama@hyo-med.ac.jp.
Tohru
T
Masuyama
D000368:Aged; D000450:Aldosterone / Q000097:blood*; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology* / Q000627:therapeutic use*; D064752:Atrial Remodeling / Q000187:drug effects*; D001713:Biphenyl Compounds / Q000494:pharmacology* / Q000627:therapeutic use*; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000494:pharmacology* / Q000627:therapeutic use*; D013997:Time Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers; D013777:Tetrazoles; D017311:Amlodipine; D000450:Aldosterone; D000077405:Irbesartan
Aldosterone; Angiotensin type II receptor blocking drugs; Calcium channel blocking drugs; Hypertension; Left atrial volume