Key result
Treatment with losartan significantly decreased plasma aldosterone concentration compared to amlodipine (-31% vs 17%, P<0.01), which correlated with left-ventricular mass regression (r=0.45, P<0.01).
Why the study?
Does the change in plasma aldosterone concentration during antihypertensive treatment with losartan or amlodipine correlate with the regression of left-ventricular mass in untreated hypertensive patients?
RCT (n=44)
Does the change in plasma aldosterone concentration during antihypertensive treatment with losartan or amlodipine correlate with the regression of left-ventricular mass in untreated hypertensive patients?
Decreases in plasma aldosterone concentration and systolic blood pressure are key determinants of left-ventricular mass regression in hypertensive patients, regardless of whether an ARB or CCB is used.
Aldosterone reduction drives LV mass regression during antihypertensive therapy; extends ARB benefits beyond BP lowering in hypertensive patients.
BACKGROUND: Aldosterone is known to bring about damage to various organs; however, it is unclear how important the changes in plasma aldosterone concentration (PAC) are as contributors to regression of left-ventricular (LV) mass in hypertensive patients following long-term treatment with calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs). OBJECTIVE: To assess the importance of changes in PAC during antihypertensive treatment. METHODS: Forty-four untreated hypertensive patients were randomly assigned to either CCB (amlodipine) group or ARB (losartan) group. In addition to PAC measurements LV geometry was echocardiographically assessed with LV mass index (LVMI) and relative wall thickness (RWT) before and 6 and 12 months after treatment. RESULTS: Reduction of systolic blood pressure (SBP) in 12 months was greater in the CCB group than in the ARB group (-19 ± 8 vs. -11 ± 15%, P < 0.05 as percentage reduction from the values before treatment). PAC decreased in 12 months in the ARB group but not in the CCB group (-31 ± 31 vs. 17 ± 53%, P < 0.01 as percentage reduction from the values before treatment). Larger percentage drop in PAC was associated with larger percentage reduction of LVMI (r = 0.45, P < 0.01 for all). Multiple step-wise regression analysis showed that the percentage reduction of LVMI is related to the percentage changes in SBP and the percentage changes in PAC (r = 0.46, P < 0.01). CONCLUSION: Regression of LV mass was the larger in patients with the greater decrease in PAC associated with antihypertensive medication regardless of CCB or ARB. Changes in PAC and SBP may be key determinants of regression of LV mass in hypertensive patients regardless of the medication selected.
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Yoshida et al. (2010) conducted an RCT in hypertension (n=44). ARB (losartan) vs. CCB (amlodipine) was evaluated on Percentage change in plasma aldosterone concentration (PAC) at 12 months (p=<0.01). Treatment with losartan significantly decreased plasma aldosterone concentration compared to amlodipine (-31% vs 17%, P<0.01), which correlated with left-ventricular mass regression (r=0.45, P<0.01).
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