Key result
Ramipril and amlodipine similarly failed to prevent the progression of left ventricular mass index and carotid intima-media thickness over 1 year in 112 nondiabetic hemodialysis patients.
Why the study?
Does ramipril compared to amlodipine improve left ventricular mass index and carotid intima-media thickness in nondiabetic hypertensive hemodialysis patients?
RCT (n=112)
Randomly allocated
Does ramipril compared to amlodipine improve left ventricular mass index and carotid intima-media thickness in nondiabetic hypertensive hemodialysis patients?
Blood pressure control with either ramipril or amlodipine does not prevent the progression of atherosclerosis or eccentric left ventricular hypertrophy in nondiabetic hemodialysis patients.
BP control with ramipril or amlodipine fails to halt LVMI or CIMT progression in nondiabetic hemodialysis; challenges expectations for these agents on uremic remodeling.
OBJECTIVE: Left ventricular hypertrophy (LVH) and atherosclerosis are frequently observed in uremic patients and they have appeared as an independent predictor of cardiovascular morbidity and mortality. The aim of this study was to compare the effects of ramipril and amlodipine on left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) in nondiabetic hypertensive hemodialysis patients. METHODS: A total of 112 hemodialysis (HD) patients were included in this study. Patients were randomly allocated to receive ramipril or amlodipine for 1 year. Blood pressure (BP) measurements, LVMI, and CIMT were assessed at baseline and 6-month intervals. Biochemical parameters and inflammatory markers were also determined at the initiation and during the study period. RESULTS: Similar BP decrease was observed in treatment groups. During follow-up, LVMI and CIMT progressed likewise in both treatment groups despite BP control. However, subgrouping analyses due to the pattern of left ventricular geometry showed that LVMI in patients with eccentric LVH increased, whereas LVMI decreased in subjects with concentric LVH under antihypertensive treatment. DISCUSSION: BP control with ramipril or amlodipine could not provide adequate protection for development or progression of atherosclerosis and eccentric type of LVH in nondiabetic HD patients.
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Yılmaz et al. (2010) conducted an RCT in Nondiabetic hypertensive hemodialysis (n=112). Ramipril vs. Amlodipine was evaluated on Left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT). Ramipril and amlodipine similarly failed to prevent the progression of left ventricular mass index and carotid intima-media thickness over 1 year in 112 nondiabetic hemodialysis patients.
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