Abstract
Purpose
Antihypertensive medications have different effects on left ventricular mass. We conducted
a meta-analysis of double-blind trials that measured the effects of antihypertensive
therapy on left ventricular mass.
Methods
Medical databases and review articles were screened for double-blind, randomized controlled
trials (through September 2002) that reported the effects of diuretics, beta-blockers,
calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin
II receptor antagonists on echocardiographic left ventricular mass in essential hypertension.
Treatment arms of the same drug class, weighted for the number of patients, were combined.
Analysis of covariance was performed to detect differences among drug classes in effects
on left ventricular structure.
Results
Eighty trials with 146 active treatment arms (n = 3767 patients) and 17 placebo arms
(n = 346 patients) were identified. Adjusted for treatment duration and change in
diastolic blood pressure, there was a significant difference (P = 0.004) among medication classes: left ventricular mass index decreased by 13% with
angiotensin II receptor antagonists (95% confidence interval [CI]: 8% to 18%), by
11% with calcium antagonists (95% CI: 9% to 13%), by 10% with ACE inhibitors (95%
CI: 8% to 12%), by 8% with diuretics (95% CI: 5% to 10%), and by 6% with beta-blockers
(95% CI: 3% to 8%). In pairwise comparisons, angiotensin II receptor antagonists,
calcium antagonists, and ACE inhibitors were more effective at reducing left ventricular
mass than were beta-blockers (all P <0.05 with Bonferroni correction).
Conclusion
Antihypertensive drug classes have different effects on left ventricular mass reduction.
Whether a greater reduction of left ventricular mass results in better clinical outcomes
remains to be determined.
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Article info
Publication history
Accepted:
February 19,
2003
Received in revised form:
February 3,
2003
Received:
November 29,
2001
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
