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A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension

  • Arnfried U Klingbeil
    Affiliations
    Department of Medicine IV (AUK, MS, RES), University of Erlangen-Nürnberg, Nürnberg, Germany

    Department of Medical Informatics, Biometry and Epidemiology (PM), Free University of Berlin, Berlin, Germany

    Alton Ochsner Foundation (FHM), New Orleans, Louisiana, USA
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  • Markus Schneider
    Affiliations
    Department of Medicine IV (AUK, MS, RES), University of Erlangen-Nürnberg, Nürnberg, Germany

    Department of Medical Informatics, Biometry and Epidemiology (PM), Free University of Berlin, Berlin, Germany

    Alton Ochsner Foundation (FHM), New Orleans, Louisiana, USA
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  • Peter Martus
    Affiliations
    Department of Medicine IV (AUK, MS, RES), University of Erlangen-Nürnberg, Nürnberg, Germany

    Department of Medical Informatics, Biometry and Epidemiology (PM), Free University of Berlin, Berlin, Germany

    Alton Ochsner Foundation (FHM), New Orleans, Louisiana, USA
    Search for articles by this author
  • Franz H Messerli
    Affiliations
    Department of Medicine IV (AUK, MS, RES), University of Erlangen-Nürnberg, Nürnberg, Germany

    Department of Medical Informatics, Biometry and Epidemiology (PM), Free University of Berlin, Berlin, Germany

    Alton Ochsner Foundation (FHM), New Orleans, Louisiana, USA
    Search for articles by this author
  • Roland E Schmieder
    Correspondence
    Requests for reprints should be addressed to Roland E. Schmieder, MD, Medizinische Klinik IV/Nephrology, University of Erlangen-Nürnberg, Breslauer Strasse 201, D-90471 Nürnberg, Germany
    Affiliations
    Department of Medicine IV (AUK, MS, RES), University of Erlangen-Nürnberg, Nürnberg, Germany

    Department of Medical Informatics, Biometry and Epidemiology (PM), Free University of Berlin, Berlin, Germany

    Alton Ochsner Foundation (FHM), New Orleans, Louisiana, USA
    Search for articles by this author

      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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