Volume control, indicated by reductions in ambulatory systolic blood pressure and inferior vena cava diameter, was the primary predictor of treatment-induced reduction in left ventricular mass index among hypertensive hemodialysis patients, whereas aortic stiffness was not.
RCT (n=179)
Open-label
1:1
No
p-value: p=0.01
This study aimed to explore the relative contribution of aortic stiffness and volume in treatment-induced change of left ventricular mass in dialysis. Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril trial compared the effect of lisinopril versus atenolol in reducing left ventricular mass index; 179 patients with echo measurements of aortic pulse wave velocity and left ventricular mass at baseline were included. In unadjusted analysis, overall reductions of 26.24 g/m2 (95% CI: -49.20, -3.29) and 35.67 g/m2 (95% CI: -63.70, -7.64) in left ventricular mass index were noted from baseline to 6 and 12 months respectively. Volume control emerged as an important determinant of regression of left ventricular mass index due to the following reasons: (i) additional control for change in ambulatory systolic blood pressure mitigated the reduction in left ventricular mass index in the statistical model above 6-month visit: -18.6 g/m2 (95% CI: -43.7, 6.5); 12-month visit: -22.1 g/m2 (95% CI: -52.2, 8.0) (ii) regression of left ventricular hypertrophy was primarily due to reduction in left ventricular chamber and not wall thickness and (iii) adjustment for inferior vena cava diameter (as a proxy for volume) removed the effect of time on left ventricular mass index reduction 6-month visit: -6.6 g/m2 (95% CI: (-41.6, 28.4); 12-month visit: 0.6 g/m2 (95% CI: -39.5, 40.7). In contrast, aortic pulse wave velocity was neither a determinant of baseline left ventricular mass index nor predictor of its reduction. Among dialysis patients, ambulatory systolic pressure, a proxy for volume expansion, but not aortic stiffness is more important predictor of reduction in left ventricular mass index. Improving blood pressure control via adequate volume management appears as an effective strategy to improve left ventricular hypertrophy in dialysis.
Georgianos et al. (Thu,) conducted a rct in Hypertension and echocardiographic left ventricular hypertrophy in end-stage renal disease on hemodialysis (n=179). Atenolol or Lisinopril (with volume management) was evaluated on Change in left ventricular mass index (LVMI) from baseline to 12 months (95% CI -63.70, -7.64, p=0.01). Volume control, indicated by reductions in ambulatory systolic blood pressure and inferior vena cava diameter, was the primary predictor of treatment-induced reduction in left ventricular mass index among hypertensive hemodialysis patients, whereas aortic stiffness was not.