Why the study?
Does lisinopril plus nifedipine improve regression of left ventricular hypertrophy compared to lisinopril plus hydrochlorothiazide in patients with hypertension uncontrolled by lisinopril alone?
Does lisinopril plus nifedipine improve regression of left ventricular hypertrophy compared to lisinopril plus hydrochlorothiazide in patients with hypertension uncontrolled by lisinopril alone?
In hypertensive patients uncontrolled by ACE inhibitor monotherapy, the addition of a calcium channel blocker provides superior regression of left ventricular hypertrophy compared to the addition of a diuretic.
May favor nifedipine over hydrochlorothiazide addition for LVMI reduction; leaves open randomized confirmation before practice change.
OBJECTIVE: Up to this date, it is well shown that several antihypertensive drugs have different regressive effect on left ventricular hypertrophy (LVH). However, there are different studies regarding the effect of antihypertensive combination therapies on regression of LVH. In this study, 2 different combinations ACE-I plus calcium channel blocker and ACE-I plus diuretic were compared in cases with hypertension whose BPs were not controlled by ACE-I alone. METHODS: Forty patients with mild to moderate hypertension were included in this study. The treatment was continued for 6 months in the Faculty of Medicine at Ege University, Turkey, between January and December 2003. Adequate response with lisinopril 20 mg/daily failed to be achieved in all patients. Patients divided into 2 groups. There were no differences between the groups in patients' age, blood pressure (BP) and other clinical and laboratory range. First group patients received lisinopril 20 mg + nifedipine GITS 30 mg and second group patients received lisinopril 20 mg + hydrochlorothiazide 25 mg. The treatment was continued for 6 months. Blood pressure were measured every 2 weeks, echocardiographic findings, and blood and urinary analysis were performed before and at the end of treatment. RESULTS: Systolic and diastolic BP decreased significantly in both groups and no significant difference regarding BP was found between the 2 groups. Left ventricular mass index also decreased significantly in both groups. However, in the first group left ventricular mass index decreased more compared to the second group. CONCLUSION: The effect of combination therapies with angiotensin converting enzyme inhibitor (ACE-I) plus diuretic and ACE-I plus calcium channel blocker on systolic and diastolic BP are similar. However, when LVH is present, regressive effect of the combination of ACE-I plus calcium channel blocker is superior to the combination of ACE-I plus diuretic.
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Boydak et al. (2004) studied this question.
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