Key result
Ramipril plus candesartan reduced left ventricular mass significantly more than ramipril plus lercanidipine (-22% vs. -12.8%, P<0.005) in never-treated hypertensive patients.
Why the study?
Does dual RAS blockade with ramipril and candesartan reduce left ventricular hypertrophy and improve diastolic function more than ramipril and lercanidipine in never-treated hypertensive patients with LV concentric hypertrophy?
RCT (n=24)
randomized
Does dual RAS blockade with ramipril and candesartan reduce left ventricular hypertrophy and improve diastolic function more than ramipril and lercanidipine in never-treated hypertensive patients with LV concentric hypertrophy?
Absolute Event Rate: -22% vs -12.8%
p-value: p=< 0.005
In a pilot study of never-treated hypertensive patients, dual RAS blockade with ramipril and candesartan reduced left ventricular mass more effectively than ramipril and lercanidipine, independent of blood pressure lowering.
Dual RAS blockade may superiorly regress LVH versus ACEi+CCB independent of BP; extends evidence in never-treated patients from small pilot RCT.
BACKGROUND: The renin-angiotensin system (RAS) plays a major role in promoting left ventricular (LV) remodeling in essential hypertension. We designed a controlled, randomized pilot study aimed to test the hypothesis that the dual RAS blockade with angiotensin-converting enzyme (ACE) inhibitor (ACEi) + angiotensin II receptor blocker (ARB) can be more effective in decreasing LV hypertrophy and improving diastolic function than a largely employed association such as ACEi + calcium-antagonist (Ca-A). METHODS: Twenty-four never-treated hypertensive patients with LV concentric hypertrophy were randomized to ramipril + candesartan or ramipril + lercanidipine. Before and after the 6-month treatment they underwent a 24-h blood pressure (BP) monitoring and echocardiographic examination. RESULTS: At baseline, age, body mass index (BMI), 24-h BP, and LV morpho-functional parameters were similar between the two groups. The 6-month treatment induced in both groups a significant decrease of 24-h BP, septal and posterior wall thickness, and LV mass index (LVMi) (ACEi + ARB 155 +/- 19 to 122 +/- 17 g/m(2), P < 0.0001; ACEi + Ca-A 146 +/- 18 to 127 +/- 20 g/m(2), P < 0.0001). Systolic function remained unchanged; LV diastolic parameters increased significantly in both groups. The extent of 24-h BP decrease was similar between the two groups (-13.3/16.3% vs. -12.3/15.8%, P = 0.63/P = 0.71), whereas the decrease of LV mass (-22% vs. -12.8%, P < 0.005) and the improvement of diastolic function were greater in ACEi + ARB group. CONCLUSIONS: In comparison with ACEi + Ca-A, ACEi + ARB treatment showed a greater antiremodeling effect, that can be reasonably ascribed to a BP-independent effect of the dual RAS blockade.
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Grandi et al. (2008) conducted an RCT in essential hypertension (n=24). ramipril + candesartan vs. ramipril + lercanidipine was evaluated on decrease of left ventricular mass (p=< 0.005). Ramipril plus candesartan reduced left ventricular mass significantly more than ramipril plus lercanidipine (-22% vs. -12.8%, P<0.005) in never-treated hypertensive patients.
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