Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects

OBJECTIVE: In hypertension, blockade of the renin-angiotensin system reduces left ventricular mass (LVM) independently of brachial systolic (S), diastolic (D), and mean (M) blood pressure (BP). From central to peripheral arteries, MBP and DBP are practically unchanged, whereas SBP and pulse pressure (PP) increase significantly. The objective was to determine whether changes in LVM under drug treatment was preferentially associated with changes in central or brachial SBP and PP. DESIGN: A substudy of 146 subjects was selected from 469 hypertensive patients submitted to a double-blind randomized trial comparing the combination of perindopril (2 mg; Per) and indapamide (0.625 mg; Ind) with atenolol (50 mg, one tablet per day). MAIN OUTCOME MEASURES: Before and after 1 year of treatment: LVM (echocardiography) in 146 subjects and, in 52 of them, central (carotid) BP and timing of wave reflections (tonometry). RESULTS: LVM changes were significantly associated with antihypertensive treatment, with lower LVM with Per/Ind than with atenolol. Changes in SBP and PP, but not in MBP and DBP, were more significantly associated with Per/Ind than with atenolol, with more pronounced effects using central than brachial measurements, and a longer delay in central return of wave reflections under Per/Ind. In the sampling of 52 patients with tonometry, the change in LVM between the two drug regimens was significantly linked to central, but not brachial, PP change. CONCLUSIONS: This observational study shows a lower LVM under Per/Ind than under atenolol. The greater change in LVM on Per/Ind was linked to central and not brachial blood pressure.