Once-daily enalapril and long-acting nifedipine achieved similar reductions in left ventricular mass index (-15 vs -17 g/m2, P>0.20) in patients with essential hypertension and increased LV mass.
RCT (n=303)
Blinded outcomes
Randomized
Yes
Does enalapril achieve greater left ventricular mass reduction than long-acting nifedipine in patients with essential hypertension and increased LV mass?
Once-daily enalapril and long-acting nifedipine are equally effective at reducing left ventricular mass in patients with essential hypertension.
Absolute Event Rate: -15% vs -17%
p-value: p=>0.20
BACKGROUND: The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) study was designed to test whether enalapril achieves greater left ventricular (LV) mass reduction than does a nifedipine gastrointestinal treatment system by a prognostically meaningful degree on a population basis (10 g/m(2)). METHODS AND RESULTS: An ethnically diverse population of 303 men and women with essential hypertension and increased LV mass at screening echocardiography were enrolled at clinical centers on 4 continents and studied by echocardiography at baseline and after 6- and 12-month randomized therapy. Clinical examination and blinded echocardiogram readings 48 weeks after study entry in an intention-to-treat analysis of 113 enalapril-treated and 122 nifedipine-treated patients revealed similar reductions in systolic/diastolic pressure (-22/12 versus -21/13 mm Hg) and LV mass index (-15 versus -17g/m(2), both P>0.20). No significant between-treatment difference was detected in population subsets defined by monotherapy treatment, sex, age, race, or severity of baseline hypertrophy. Similarly, there was no between-treatment difference in change in velocities of early diastolic or atrial phase transmitral blood flow. More enalapril-treated than nifedipine-treated patients required supplemental treatment with hydrochlorothiazide (59% versus 34%, P<0.001) but not atenolol (27% versus 22%, NS). CONCLUSIONS: Once-daily antihypertensive treatment with enalapril or long-acting nifedipine, plus adjunctive hydrochlorothiazide and atenolol when needed to control blood pressure, both had moderately beneficial and statistically indistinguishable effects on regression of LV hypertrophy.
Devereux et al. (Tue,) conducted a rct in Essential hypertension and increased LV mass (n=303). Enalapril vs. Nifedipine gastrointestinal treatment system was evaluated on Reduction in left ventricular mass index (p=>0.20). Once-daily enalapril and long-acting nifedipine achieved similar reductions in left ventricular mass index (-15 vs -17 g/m2, P>0.20) in patients with essential hypertension and increased LV mass.