title: Greater efficacy of aldosterone blockade and diuretic reinforcement vs. dual renin-angiotensin blockade for left ventricular mass regression in patients with resistant hypertension.
abstract: OBJECTIVE
  We report the results of an echocardiographic substudy carried out in a trial comparing the effects of two different treatment strategies - mineralocorticoid receptor blockade (MRB) and dual renin-angiotensin system blockade (RASB) - in patients with resistant hypertension. Both strategies reduce left ventricular mass index (LVMI), but they have not been compared in patients with resistant hypertension.
  
  
  METHODS
  After 4-week treatment with 300 mg irbesartan + 12.5 mg hydrochorothiazide + 5 mg amlodipine, 86 patients with resistant hypertension were randomized to the add-on 25 mg spironolactone (MRB group, n = 46) or 5 mg ramipril (RASB group, n = 40) groups for 12 weeks. Treatment intensity was increased at week 4, 8 or 10 if home blood pressure (BP) was equal to or above 135/85 mmHg, by sequentially adding 20-40 mg furosemide and 5 mg amiloride (MRB group), or 10 mg ramipril and 5-10 mg bisoprolol (RASB group). Transthoracic echography was performed at baseline and week 12.
  
  
  RESULTS
  Daytime ambulatory BP decreased by 19 ± 12/11 ± 8 mmHg in the MRB group and by 8 ± 13/7 ± 7 mmHg in the RASB group (P = 0.0003/0.03). LVMI decreased by 8.2 ± 18.9 g/m in the MRB group, whereas it increased by 1.8 ± 19.1 g/m in the RASB group (P = 0.03). The decreases in posterior wall thickness, left ventricular (LV) end-systolic diameter, E/e' ratio and left atrial area were significantly greater with MRB than with RASB. The difference between groups remained significant after adjustment for the decrease in ambulatory BP.
  
  
  CONCLUSIONS
  In patients with resistant hypertension, MRB-based treatment decreased both BP and LVMI more efficiently than a strategy based on dual RASB.
authors.affiliation: aAssistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, F75015, Paris bInserm, Clinical Investigation Centre, F75015, Paris cUniversité Paris-Descartes, F75006 Paris dAssistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, F75015, Paris eInserm, CIE 4, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Azizi
authors.forename: Ludivine
authors.initials: L
authors.lastname: Perdrix
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bobrie
authors.forename: Michael
authors.initials: M
authors.lastname: Frank
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Joël
authors.initials: J
authors.lastname: Ménard
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Plouin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism*; D000584:Amiloride / Q000627:therapeutic use; D017311:Amlodipine / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000627:therapeutic use; D017298:Bisoprolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000209:etiology; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D017257:Ramipril / Q000627:therapeutic use; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects; D013148:Spironolactone / Q000627:therapeutic use; D013777:Tetrazoles / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001713:Biphenyl Compounds; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013777:Tetrazoles; D017311:Amlodipine; D013148:Spironolactone; D000450:Aldosterone; D000584:Amiloride; D005665:Furosemide; D012083:Renin; D000077405:Irbesartan; D017257:Ramipril; D017298:Bisoprolol