Greater efficacy of aldosterone blockade and diuretic reinforcement vs. dual renin-angiotensin blockade for left ventricular mass regression in patients with resistant hypertension.

Abstract

OBJECTIVES:

We report the results of an echocardiographic substudy carried out in a trial comparing the effects of two different treatment strategies - mineralocorticoid receptor blockade (MRB) and dual renin-angiotensin system blockade (RASB) - in patients with resistant hypertension. Both strategies reduce left ventricular mass index (LVMI), but they have not been compared in patients with resistant hypertension.

METHODS:

After 4-week treatment with 300 mg irbesartan + 12.5 mg hydrochorothiazide + 5 mg amlodipine, 86 patients with resistant hypertension were randomized to the add-on 25 mg spironolactone (MRB group, n = 46) or 5 mg ramipril (RASB group, n = 40) groups for 12 weeks. Treatment intensity was increased at week 4, 8 or 10 if home blood pressure (BP) was equal to or above 135/85 mmHg, by sequentially adding 20-40 mg furosemide and 5 mg amiloride (MRB group), or 10 mg ramipril and 5-10 mg bisoprolol (RASB group). Transthoracic echography was performed at baseline and week 12.

RESULTS:

Daytime ambulatory BP decreased by 19 ± 12/11 ± 8 mmHg in the MRB group and by 8 ± 13/7 ± 7 mmHg in the RASB group (P = 0.0003/0.03). LVMI decreased by 8.2 ± 18.9 g/m in the MRB group, whereas it increased by 1.8 ± 19.1 g/m in the RASB group (P = 0.03). The decreases in posterior wall thickness, left ventricular (LV) end-systolic diameter, E/e' ratio and left atrial area were significantly greater with MRB than with RASB. The difference between groups remained significant after adjustment for the decrease in ambulatory BP.

CONCLUSION:

In patients with resistant hypertension, MRB-based treatment decreased both BP and LVMI more efficiently than a strategy based on dual RASB.

• Authors: Michel Azizi, Ludivine Perdrix, Guillaume Bobrie, Michael Frank, Gilles Chatellier, Joël Ménard, Pierre-François Plouin
• Journal: Journal of hypertension (J Hypertens) Vol. 32 Issue 10 Pg. 2038-44; discussion 2044 (Oct 2014) ISSN: 1473-5598 [Electronic] England
• PMID: 24983187 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Biphenyl Compounds
• Diuretics
• Mineralocorticoid Receptor Antagonists
• Tetrazoles
• Amlodipine
• Spironolactone
• Aldosterone
• Amiloride
• Furosemide
• Renin
• Irbesartan
• Ramipril
• Bisoprolol

Topics

• Adolescent
• Adult
• Aged
• Aldosterone (metabolism)
• Amiloride (therapeutic use)
• Amlodipine (therapeutic use)
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Biphenyl Compounds (therapeutic use)
• Bisoprolol (therapeutic use)
• Blood Pressure (drug effects)
• Blood Pressure Determination
• Diuretics (therapeutic use)
• Drug Therapy, Combination
• Female
• Furosemide (therapeutic use)
• Humans
• Hypertension (drug therapy, etiology)
• Hypertrophy, Left Ventricular (drug therapy, etiology)
• Irbesartan
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Ramipril (therapeutic use)
• Renin (blood)
• Renin-Angiotensin System (drug effects)
• Spironolactone (therapeutic use)
• Tetrazoles (therapeutic use)
• Young Adult