What is the clinical evidence from this study?

Study design: RCT. Population: end-stage renal disease (ESRD) with left ventricular hypertrophy (LVH) (n=24). Intervention: perindopril vs. nitrendipine. Primary outcome: Left ventricular mass (LVM) (p=0.036).

What does this research mean for the field?

In end-stage renal disease patients with left ventricular hypertrophy, ACE inhibition with perindopril significantly reduces left ventricular mass independently of blood pressure lowering, unlike calcium channel blockade with nitrendipine. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the blood pressure-dependent and blood pressure-independent effects of ACE inhibition versus calcium channel blockade on arterial hemodynamics and left ventricular hypertrophy in end-stage renal disease.

December 1, 1994Circulation

Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.

Q: What are the key findings of this study?

Perindopril significantly decreased left ventricular mass from 317 g to 247 g compared to nitrendipine (P=0.036) in ESRD patients with LVH, independently of blood pressure reduction.

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Key result

Perindopril reduces LV mass ~22% vs. nitrendipine in ESRD patients with LVH.

P=0.036
n=24

Why the study?

The respective roles of antihypertensive and blood pressure-independent effects of antihypertensive drugs on arterial hemodynamics and LVH in ESRD patients were unclear.

Does perindopril compared to nitrendipine reduce left ventricular mass and improve arterial hemodynamics in ESRD patients with LVH?

Population

24 ESRD patients with LVH

Comparison

Perindopril (ACE inhibitor) vs nitrendipine (calcium channel blocker)

Design

Double-blind randomized controlled trial

Follow-up

12 months

Authors

GLGérard M. LondonVascular Medicine BPBruno PannierDélégation Paris 5 AGAlain P. GuérinVascular Medicine

Discussion

Member takes

Implication

Supports ACE inhibitor preference for LVH regression in ESRD; extends BP-independent remodeling benefits to dialysis patients.

Key Points

To evaluate the blood pressure-dependent and blood pressure-independent effects of ACE inhibition versus calcium channel blockade on arterial hemodynamics and left ventricular hypertrophy in end-stage renal disease.
In a double-blind trial, 24 patients with end-stage renal disease and left ventricular hypertrophy were randomized to 12 months of perindopril (n = 14) or nitrendipine (n = 10).
Assessments included blood pressure, echocardiographic left ventricular mass and dimensions, arterial pulse wave velocity, applanation tonometry, and neurohormone levels analyzed with two-way repeated-measures ANOVA.
Both perindopril and nitrendipine induced significant decreases in blood pressure, total peripheral resistance (P < .001), pulse wave velocity (P < .001), and arterial wave reflections (P < .01).
Left ventricular mass decreased significantly only in the perindopril arm (from 317 ± 18 to 247 ± 21 g; time-treatment interaction P = .036) compared to nitrendipine (314 ± 29 to 286 ± 32 g).
The reduction with perindopril was driven by decreased left ventricular end-diastolic diameter (49.9 ± 1.6 vs 54.3 ± 1.4 mm; P = .04) rather than wall thickness changes, and occurred independently of blood pressure or neurohormone alterations.

Study Design

Type

RCT (n=24)

Blinding

Double-blind

Randomization

randomized

Structured PICO

Does perindopril compared to nitrendipine reduce left ventricular mass and improve arterial hemodynamics in ESRD patients with LVH?

Population

24 end-stage renal disease (ESRD) patients with left ventricular hypertrophy (LVH)

Intervention

Perindopril (ACE inhibitor) for 12 months (n=14)

Comparator

Nitrendipine (calcium channel blocker) for 12 months (n=10)

Outcome

Changes in left ventricular mass (LVM) and arterial hemodynamics (blood pressure, total peripheral resistance, aortic and large-artery compliance, arterial wave reflections) at 12 monthssurrogate

Main Result

Absolute Event Rate: 247% vs 286%

p-value: p=0.036

In ESRD patients with LVH, ACE inhibition with perindopril decreases left ventricular mass independently of its antihypertensive effect, primarily by reducing LV volume.

Cite This Study

London et al. (1994) conducted an RCT in end-stage renal disease (ESRD) with left ventricular hypertrophy (LVH) (n=24). perindopril vs. nitrendipine was evaluated on Left ventricular mass (LVM) (p=0.036). Perindopril significantly decreased left ventricular mass from 317 g to 247 g compared to nitrendipine (P=0.036) in ESRD patients with LVH, independently of blood pressure reduction.

synapsesocial.com/papers/6a0f973f64e8141cd25fbc5b https://doi.org/10.1161/01.cir.90.6.2786

Topics

Echocardiography

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Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Cardiac hypertrophy, aortic compliance, peripheral resistance, and wave reflection in end-stage renal disease. Comparative effects of ACE inhibition and calcium channel blockade.

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider