Roberto Fogari1, Annalisa Zoppi, Amedeo Mugellini, Pamela Maffioli, Paola Preti, Giuseppe Derosa. 1. University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics, Fondazione IRCC Policlinico S. Matteo, Piazzale Golgi 19, 27100 Pavia, Italy. r.fogari@unipv.it
Abstract
OBJECTIVE: The objective of this study was to compare valsartan or ramipril addition to amlodipine + hydrochlorothiazide (HCTZ) on blood pressure (BP) and left ventricular hypertrophy (LVH) in hypertensive diabetic patients with LVH. RESEARCH DESIGN AND METHODS: 293 patients were treated with amlodipine 10 mg + HCTZ 12.5 combination and then randomized to receive valsartan 160 mg or ramipril 5 mg, in addition to the previous therapy, for 1 year. MAIN OUTCOME MEASURES: Clinic BP was measured every month; echocardiographic assessments were performed at the end of the placebo period, both before the randomization and after 1-year of triple combination therapy. RESULTS: Both triple regimens similarly reduced SBP/DBP values (-13.5/10.9 mm Hg in the valsartan group and -13.4/10.4 mm Hg in the ramipril group). Triple combination including valsartan better reduced LVMI (-20.1%, p < 0.001), interventricular septal thickness (IVST) (-20.3%, p < 0.001) and left ventricular posterior wall thickness (PWT) (-16.3%, p < 0.001), compared with triple combination including ramipril (-14%, p < 0.01; -16.2%, p < 0.001 and -9%, p < 0.01, respectively); the difference between treatments being statistically significant (p < 0.05). Triple combination with valsartan gave a greater increase of E/A ratio (p < 0.05 between groups). CONCLUSIONS:Valsartan addition to dual therapy with amlodipine + HCTZ was more effective than ramipril addition in reducing LVH.
RCT Entities:
OBJECTIVE: The objective of this study was to compare valsartan or ramipril addition to amlodipine + hydrochlorothiazide (HCTZ) on blood pressure (BP) and left ventricular hypertrophy (LVH) in hypertensive diabeticpatients with LVH. RESEARCH DESIGN AND METHODS: 293 patients were treated with amlodipine 10 mg + HCTZ 12.5 combination and then randomized to receive valsartan 160 mg or ramipril 5 mg, in addition to the previous therapy, for 1 year. MAIN OUTCOME MEASURES: Clinic BP was measured every month; echocardiographic assessments were performed at the end of the placebo period, both before the randomization and after 1-year of triple combination therapy. RESULTS: Both triple regimens similarly reduced SBP/DBP values (-13.5/10.9 mm Hg in the valsartan group and -13.4/10.4 mm Hg in the ramipril group). Triple combination including valsartan better reduced LVMI (-20.1%, p < 0.001), interventricular septal thickness (IVST) (-20.3%, p < 0.001) and left ventricular posterior wall thickness (PWT) (-16.3%, p < 0.001), compared with triple combination including ramipril (-14%, p < 0.01; -16.2%, p < 0.001 and -9%, p < 0.01, respectively); the difference between treatments being statistically significant (p < 0.05). Triple combination with valsartan gave a greater increase of E/A ratio (p < 0.05 between groups). CONCLUSIONS:Valsartan addition to dual therapy with amlodipine + HCTZ was more effective than ramipril addition in reducing LVH.
Authors: Giuseppe Derosa; Arrigo F G Cicero; Anna Carbone; Fabrizio Querci; Elena Fogari; Angela D'Angelo; Pamela Maffioli Journal: Inflammation Date: 2014-02 Impact factor: 4.092