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Hydrochlorothiazide Is Superior to Isradipine for Reduction of Left Ventricular Mass: Results of a Multicenter Trialfn1fn1 This study was supported by an unrestricted grant from Sandoz Pharmaceuticals, East Hanover, New Jersey.fn2fn2 To discuss this article on-line, visit the ACC Home Page at http://www.acc.org/members and click on the JACC Forum

Authors
Journal
Journal of the American College of Cardiology
0735-1097
Publisher
Elsevier
Publication Date
Volume
30
Issue
7
Identifiers
DOI: 10.1016/s0735-1097(97)00311-2
Keywords
  • Hypertension
Disciplines
  • Design
  • Medicine

Abstract

Abstract Objectives. We sought to determine the efficacy of isradipine in reducing left ventricular (LV) mass and wall thickness in hypertensive patients. Background. LV hypertrophy on the echocardiogram is a strong predictor of cardiovascular events. Reduction of LV mass may be a desirable goal of drug therapy for hypertension. However, although thiazide diuretic drugs have been advocated as first-line therapy for hypertension, their efficacy in reducing LV mass has been questioned. Methods. Patients with mild to moderate diastolic hypertension and LV mass in excess of 1 SD of normal values were randomized to isradipine (n = 89) or hydrochlorothiazide therapy (n = 45). Evaluations were obtained at baseline, after 3 and 6 months of treatment and 2 weeks after treatment was stopped. Results. At 6 months, LV mass decreased by 43 ± 45 g (mean ± SD) with hydrochlorothiazide (p < 0.001) but only by 11 ± 48 g with isradipine (p = NS; between-group comparison, p < 0.001). Two weeks after drug therapy was stopped, LV mass remained 24 ± 41 g lower than that at baseline in the hydrochlorothiazide group (p = 0.003) but only 7 ± 50 g lower in the isradipine group (p = NS). Septal and posterior wall thicknesses were significantly and equally reduced with both isradipine and hydrochlorothiazide. Greater LV mass reduction with hydrochlorothiazide was related to a 2.8 ± 3.3-mm reduction of LV cavity size with hydrochlorothiazide but no reduction with isradipine. At 6 months of treatment, diastolic blood pressure (BP) by design was equally reduced in both treatment groups. At 3 months, systolic BP was reduced by 17 ± 15 mm Hg with isradipine and by 26 ± 15 and 25 ± 17 mm Hg at 3 and 6 months, respectively, with hydrochlorothiazide (p = 0.003, between-group comparison). However, on stepwise multivariable regression analysis, treatment selection (partial r 2 = 0.082, p = 0.001), change in average 24-h systolic BP (partial r 2 = 0.032, p = 0.029) and change in average sitting systolic BP (partial r 2 = 0.017, p = 0.096) were predictive of LV mass reduction. Conclusions. Despite an equivalent reduction of diastolic BP, 6 months of therapy with hydrochlorothiazide is associated with a substantial reduction of LV mass, greater than that with isradipine. The superior efficacy of hydrochlorothiazide for LV mass reduction is associated with a greater reduction of systolic BP as well as drug selection itself. These data may have important therapeutic implications.

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