What is the clinical evidence from this study?

Study design: RCT. Population: essential hypertension (n=24). Intervention: ramipril + candesartan vs. ramipril + lercanidipine. Primary outcome: decrease of left ventricular mass (p=< 0.005).

January 3, 2008Open Access

Effects of Dual Blockade of Renin-Angiotensin System on Concentric Left Ventricular Hypertrophy in Essential Hypertension: a Randomized, Controlled Pilot Study

Q: What are the key findings of this study?

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.

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.

Study Design

Type

RCT (n=24)

Randomization

randomized

PICO

Population

24 never-treated hypertensive patients with left ventricular concentric hypertrophy, followed for 6 months.

Intervention / Comparator

ramipril + candesartan vs ramipril + lercanidipine

Primary Outcome

decrease of left ventricular mass, p=< 0.005

Main Result

Absolute Event Rate: -22% vs -12.8%

p-value: p=< 0.005

Abstract

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.